Care Home: Kings Court Care Centre

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well The provider is open to identifying and being advised on areas where change is needed and is able to make improvements where indicated. The provider is prepared to invest financially in the home to make improvements. Staff are highly motivated and show knowledge of how to meet the needs of people with complex needs, including dementia and are keen to treat people as individuals. Support services such as administration, catering, domestic and laundry services work to ensure that they provide high standards of care and fully support the staff who are providing care. People expressed their appreciation of services provided. One person reported "they do listen to me and act promptly", another that staff are "REALLY EXCELLENT", another "we have always received the utmost cooperation and consideration" and another "we have total confidence in the care received by [my relative]". One resident described a particular member of staff, reporting "she`s lovely" and another pointed towards a member of staff, stating "I loves her". What has improved since the last inspection? At the last inspection, this service was rated as having poor outcomes for residents, with 24 statutory requirements identified and 20 good practice recommendations. By this inspection, the improvements have been such that Kings Court is now rated as having good outcomes for residents and all of the requirements have been addressed. Major improvements have been made in care provision. Where a resident has a need or risk, care plans are put in place to direct staff on how the person`s needs are to be met or risk reduced, this includes plans relating to dementia care needs. Staff were aware of these care plans. Where a resident`s needs have changed, assessments and plans are up-dated to direct staff on how the person`s changed needs are to be met. Staff are now providing care in accordance with care plans. Records of nursing and care are in place. These records are accurate and were completed at the time care was given. The home now actively considers residents` diverse social, emotional, cultural psychological needs when providing care. Records of activities include how the resident has benefited from a particular activity. Improvements have been made in management of medicines. Only Controlled Drugs are stored in Controlled Drugs Cupboard. Practice in homely medicines has been revised and improved. The medicines trolley is always secured during medicines rounds. Registered nurses now only sign the medicines record once the resident has taken their medication. The registered nurses have been enabled to concentrate on the medicines round and not be expected to perform other roles as well. Care plans relating to medications have been further developed. Improvements have been made in safeguarding vulnerable people, including more effective reporting systems and ensuring that vulnerable residents are protected from residents with complex dementia care needs. Advances have been made in apparently small but significant areas, such as ensuring that residents` clothes are marked with their name. Staff now sit with residents when assisting them to eat, so that they can ensure that a person is swallowing safely and to engage the person in conversation. Many improvements have been made in the home environment, including provision of an attractive and safe hairdressing room, redecoration and recarpeting of corridors, provision of new furniture, fitments and bed linen. An action plan has been developed to improve the lower ground floor. Support kitchens are now clean and items stored in fridges correctly labelled. Equipment and furnishings are clean and free of debris. The laundry is also clean and an action plan has been developed to fully up-grade the facility. Staff performance when handling all categories of laundry has improved. A full review of staffing levels has taken place and the numbers of care and activities staff have been increased. Staff have been trained in dementia care. Staff are now being supervised in their roles and records of supervision are maintained. Items handed in for safekeeping are correctly stored and records maintained. Work has commenced on revising information given to residents and this will be further progressed by the new manager. What the care home could do better: Two requirements and fifteen good practice recommendations were made at this inspection. The home needs to improve its systems for the management of prevention of pressure ulceration, to ensure that all residents are assessed for risk. When a risk of pressure ulceration is identified, a care plan needs to be put in place. All care plans need to be completed to the same standards, to clearly direct staff on actions to take to prevent risk. Monitoring records need to be in place for all people assessed as being at risk of pressure ulceration, these monitoring records need to show that care is being given in accordance with care plans. All nursing and care staff should be trained in the prevention of pressure ulceration and the importance of documentation in this field. All records relating to nursing and care need to be signed and dated by the person drawing up the document, so that information is available on who drew up the document and when it should be reviewed. All parts of care plans should be regularly reviewed. All care records should describe interventions and needs precisely, so that if a need is identified in a care plan, the actions totake to meet the need are clearly described. Where actions are identified in records, there should be evidence that they have been taken. Descriptions such as "aggression" or "sore bottom", without also providing a clear description of the symptoms presented, should be avoided. Where a resident`s fluid intake is being measured, all fluids given, including sips, should be documented. Improvements could be made in medicines storage, including the controlled drugs cupboards being fully secured to a solid wall and an area for staff to work safely with medicines delivered to the home. Recording sheets for external preparations would benefit from improvement. If medicines are crushed or altered in some way, this should be checked with the pharmacist, to ensure that they are not affected. All staff who may be in charge of the home need to receive training in their responsibilities in the event of a safeguarding allegation. Staff should be supported in ensuring that all complaints raised by people are reported to management. Residents` past interests should be documented in their personal profiles, so that this information can be considered when planning care. As Kings Court provides care to people with communication difficulties, such records should also state where information was obtained from. Accessible information should be provided about the home for people with dementia care needs. All topical applications should be labelled with the person`s name, to avoid risk of communal use if left in bathrooms or shower rooms. The home should consider additional systems to ensure that all residents have their clothes named, to further reduce the number of un-named clothes. Gaps in flooring should be sealed to prevent potential dirt traps. CARE HOMES FOR OLDER PEOPLE Kings Court Care Centre Kent Road Swindon Wiltshire SN1 3NP Lead Inspector Susie Stratton Unannounced Inspection 09:40 25 February 2009 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kings Court Care Centre Address Kent Road Swindon Wiltshire SN1 3NP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01793 715480 01793 715490 kingscourt@schealthcare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd Vacant Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 60 28th August 2008 2. Date of last inspection Brief Description of the Service: Kings Court Care Centre is situated in the Old Town area of Swindon close to the town centre, local shops, churches and local bus routes. The centre comprises of a two-storey purpose built nursing home with general nursing and dementia nursing units on separate floors. All rooms are single and have en suite facilities. The garden is fully wheelchair accessible. There is car parking on site and a bus stop close by. The home is part of the Southern Cross group. The registered manager’s post is currently vacant. There are registered nurses on duty at all times in both units, supported by care assistants. Ancillary support includes activity, catering, domestic, maintenance and administration services. The current range of fees is £469.44 to £750 per week. A service users’ guide is available in each resident’s room and in the front entrance hall. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 35 questionnaires were sent out to residents and staff and 11 were returned. Comments made by people in questionnaires, during the inspection and observations made during the site visit have been included when drawing up the report. As part of this inspection, the home’s service file was reviewed and information provided since the previous inspection, including their improvement plan, were considered. This helped us to decide what we should focus on during the visit to the home. The site visits took place on Wednesday 25th February 2009 between 9:40 am and 4:30pm. Two regulatory inspectors and a pharmacist inspector performed the inspection and these persons are referred to as “we” throughout the report, as the report is made on behalf of the Commission for Social Care Inspection (CSCI). The operations manager made herself available during the site visit and we were able to feed back to her at the end of the day. During the site visit, we met with three residents, one visitor and observed care for seven residents for whom communication was difficult on the ground floor. As the first floor of Kings Court provides dementia care, we concentrated on observing a variety of care provision to different residents on this floor. We observed care provision across the home, including staff interaction with residents in the four sitting rooms and two dining rooms at different times of the day. We reviewed documentation in detail for seven residents, one of whom was a respite care user, one who had been admitted recently and one who was from an ethnic minority and we also considered specific matters for a further five residents. As well as meeting with residents, we met with the manager who was supporting the operations manager in overseeing the home, four registered nurses, ten carers, the chef, the administrator, the activities coordinator, two cleaners and a laundress. We toured all the building, including most bedrooms and en-suites, all of the sitting and dining rooms, bathrooms and wcs. We observed practice, including lunch-time meals, planned and ad-hoc activities sessions and when people were sitting more quietly in day rooms or moving round the home. Our pharmacist inspector observed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including the Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 6 complaints log, maintenance log, night record, day book, statement of purpose and service users’ guide. What the service does well: What has improved since the last inspection? At the last inspection, this service was rated as having poor outcomes for residents, with 24 statutory requirements identified and 20 good practice recommendations. By this inspection, the improvements have been such that Kings Court is now rated as having good outcomes for residents and all of the requirements have been addressed. Major improvements have been made in care provision. Where a resident has a need or risk, care plans are put in place to direct staff on how the person’s needs are to be met or risk reduced, this includes plans relating to dementia care needs. Staff were aware of these care plans. Where a resident’s needs have changed, assessments and plans are up-dated to direct staff on how the person’s changed needs are to be met. Staff are now providing care in accordance with care plans. Records of nursing and care are in place. These records are accurate and were completed at the time care was given. The home now actively considers residents’ diverse social, emotional, cultural psychological needs when providing care. Records of activities include how the resident has benefited from a particular activity. Improvements have been made in management of medicines. Only Controlled Drugs are stored in Controlled Drugs Cupboard. Practice in homely medicines has been revised and improved. The medicines trolley is always secured during medicines rounds. Registered nurses now only sign the medicines record once the resident has taken their medication. The registered nurses have been enabled to concentrate on the medicines round and not be expected Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 7 to perform other roles as well. Care plans relating to medications have been further developed. Improvements have been made in safeguarding vulnerable people, including more effective reporting systems and ensuring that vulnerable residents are protected from residents with complex dementia care needs. Advances have been made in apparently small but significant areas, such as ensuring that residents’ clothes are marked with their name. Staff now sit with residents when assisting them to eat, so that they can ensure that a person is swallowing safely and to engage the person in conversation. Many improvements have been made in the home environment, including provision of an attractive and safe hairdressing room, redecoration and recarpeting of corridors, provision of new furniture, fitments and bed linen. An action plan has been developed to improve the lower ground floor. Support kitchens are now clean and items stored in fridges correctly labelled. Equipment and furnishings are clean and free of debris. The laundry is also clean and an action plan has been developed to fully up-grade the facility. Staff performance when handling all categories of laundry has improved. A full review of staffing levels has taken place and the numbers of care and activities staff have been increased. Staff have been trained in dementia care. Staff are now being supervised in their roles and records of supervision are maintained. Items handed in for safekeeping are correctly stored and records maintained. Work has commenced on revising information given to residents and this will be further progressed by the new manager. What they could do better: Two requirements and fifteen good practice recommendations were made at this inspection. The home needs to improve its systems for the management of prevention of pressure ulceration, to ensure that all residents are assessed for risk. When a risk of pressure ulceration is identified, a care plan needs to be put in place. All care plans need to be completed to the same standards, to clearly direct staff on actions to take to prevent risk. Monitoring records need to be in place for all people assessed as being at risk of pressure ulceration, these monitoring records need to show that care is being given in accordance with care plans. All nursing and care staff should be trained in the prevention of pressure ulceration and the importance of documentation in this field. All records relating to nursing and care need to be signed and dated by the person drawing up the document, so that information is available on who drew up the document and when it should be reviewed. All parts of care plans should be regularly reviewed. All care records should describe interventions and needs precisely, so that if a need is identified in a care plan, the actions to Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 8 take to meet the need are clearly described. Where actions are identified in records, there should be evidence that they have been taken. Descriptions such as “aggression” or “sore bottom”, without also providing a clear description of the symptoms presented, should be avoided. Where a resident’s fluid intake is being measured, all fluids given, including sips, should be documented. Improvements could be made in medicines storage, including the controlled drugs cupboards being fully secured to a solid wall and an area for staff to work safely with medicines delivered to the home. Recording sheets for external preparations would benefit from improvement. If medicines are crushed or altered in some way, this should be checked with the pharmacist, to ensure that they are not affected. All staff who may be in charge of the home need to receive training in their responsibilities in the event of a safeguarding allegation. Staff should be supported in ensuring that all complaints raised by people are reported to management. Residents’ past interests should be documented in their personal profiles, so that this information can be considered when planning care. As Kings Court provides care to people with communication difficulties, such records should also state where information was obtained from. Accessible information should be provided about the home for people with dementia care needs. All topical applications should be labelled with the person’s name, to avoid risk of communal use if left in bathrooms or shower rooms. The home should consider additional systems to ensure that all residents have their clothes named, to further reduce the number of un-named clothes. Gaps in flooring should be sealed to prevent potential dirt traps. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective residents will be provided with information about the service and will benefit from a full assessment, prior to admission so that they can be assured that the home will be able to meet their individual needs. EVIDENCE: The home’s statement of purpose and service users’ guide are available in the front entrance area and the service user’s guide is available in each resident’s own bedroom. A review of these documents indicated that following the last inspection, work had commenced on up-dating and developing these documents. It is appreciated that some areas will need further up-dating now that the previous registered manager has left her post. The operations manager reported that this will be developed by the prospective manager, when she comes in post. The service users’ guide gave useful information for visitors to refer to, but was not suited to the needs of people with dementia. A Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 11 brief single page containing basic simple facts about the home and its location, using large font and pictures, could be reassuring to some residents. The home has not had many admissions since the last inspection. For the most recently admitted person, a pre-admission assessment was carried out, using a standard document. All sections were completed and showed attention to detail. The assessment was sufficiently detailed to demonstrate that the person’s needs could be met by the home. The information gathered was used to set up the initial care plan. In all records seen there was evidence of close liaison with mental health professionals, including use of CPA care plans and reviews. For a person admitted for a short stay, a full assessment was carried out before admission. People responded variably in questionnaires about admission to the home. One person reported that although information was useful before admission, the only way to really find out about the home was when they moved in. Another person reported that they had been admitted in an emergency, so there had not been time for any information, but that they “felt that Kings Court would have been the choice”. Another person reported “A most happy choice!” Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has much improved its response to meeting residents’ needs and residents will now be fully supported and cared for as an individual, in a way that meets their diverse nursing and care needs. There are few areas which could present some risk to residents, particularly for those who may be at risk of pressure ulceration. People are protected by the home’s procedures for the safe handling of medicines. EVIDENCE: Kings Court have put a large amount of effort into developing their approach to assessment and care planning since the last inspection. This was reflected in comments made to us. One person reported that they had “always received the utmost cooperation and consideration”, another “they give [my relative] care and affection” and another “I think it’s very good”. Staff spoken with Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 13 were aware of residents’ needs and many reported that now that staffing levels had been improved, they felt they had more time to spend with residents and to familiarise themselves with how each resident’s care needs were to be met. Improvements have been made in a wide range of areas relating to care, for example, at the last inspection, we observed some residents not to have had their personal needs met, including observations of unclean fingernails, mouths and unbrushed hair. This was not observed for any resident during this inspection. We observed in particular for one resident who had been reported the have some complex behaviours in relation to being able to agree to having personal care, that they now appeared to be more relaxed and they now had clean fingernails, which had been attractively nail varnished, which it was documented that they liked. For people with dementia, care plans included a dementia assessment tool. This helped identify what abilities a person retained, as well as deficits to be addressed. Care plans were kept in people’s bedside lockers. They began with Personal Preference Plans. These were written in the first person and stressed how people liked to receive care. They gave clear guidance to preferred morning and evening routines, and any assistance necessary to eating and drinking, baths and showers, and mobilising. Significant details were included, such as that the person become alarmed by too much noise, or for another person, a precise description of the type of clothes they preferred to wear. Any behavioural tendencies were both described and explained, with guidance to staff on how to interpret and respond to behaviours in order to reduce a person’s stress. These very useful plans could be further improved by showing when and by whom they were compiled, and when and how they were reviewed. As the home cares for people with dementia care needs who may find communication complex, it would be helpful also to show how some information was obtained. We observed that carers complied with these plans when providing care. Several carers we spoke with showed a detailed knowledge of their resident’s needs. One carer described how one of the residents in their area responded to particular types of music when providing care. As noted above, the home has much developed its assessment, care planning and general record-keeping systems since the last inspection particularly in relation to dementia care. Staff kept daily records of care given to all residents. These were objective and thus aided six-monthly care plan reviews and external reviews by funding authorities. Nearly all care plans were regularly evaluated and up-dated when indicated. The quality of evaluation indicated that it was a task undertaken purposefully. Additions and changes to care plans showed they were working documents. As an example, a member of staff described how a person’s eating preferences had become known after their admission, and the detail had been added to their care plan. Other records were also in place. For example where residents needed continence aids such as pads, there are instructions in their rooms to state they type of Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 14 pad to be used and the changing regime. Residents’ weights were monitored, and significant changes investigated. We saw examples of responses to people’s cultural needs. A care assistant spoke to us of the importance of care plans. They reported that at shift handovers, they were directed to read changes to individual care plans. As so many issues were identified at the previous inspection, a few areas continue to need improvement. This is understandable and the amount of work already put in by this inspection is impressive. Most care plans and clear and detailed and written in a person-centred, non judgemental style. A few still need some attention, with wording such as “aggression” documented, without stating what type of aggression was shown by the resident. In a very few cases, not all parts of care plans were evaluated. For example, whilst the use of safety rails were evaluated in nearly all cases, for one resident, evaluations had not been taking place. In a few cases, daily records would benefit from precise language. For example one resident’s records stated that they had a “sore bottom”, without stating where the sore area was observed or a more precise description of the tissue damage observed. Some records relating to continence care in residents’ rooms were dated and signed but others were not. This is needed to identify who drew up the plan and when it needed to be evaluated. Where residents needed support with taking in fluids or eating food, charts were maintained, so that staff could assess if the person had had enough to eat or drunk enough. These records were fully completed at the time care was given. Where fluid or continence monitoring was undertaken, recording sheets suggested this was well understood by staff. Fluid charts were all totalled every 24 hours, so that risks of dehydration could be assessed. Several charts indicated that residents were not given fluids after 6:00pm. The condition of residents’ mouths indicated that this was unlikely to be the case. Night staff should be reminded to document fluids given to residents, even if the resident is only able to take in a few sips. A person had been referred for assessment by the speech and language therapist. This resulted in guidance about thickening the person’s drinks to aid swallowing. This was incorporated into their care plan and we saw it complied with at the meal table. For the same person, a care plan for oral health had also been started as the result of an oral health assessment. Other staff were observed elsewhere in the home to give residents who needed thickening agent drinks with the correct amount of thickening agent, as documented in their care plans. One area that still needs attention by the home is consistency in approach to prevention of pressure ulcers. Nearly all residents had assessments for risk of pressure damage, which were regularly reviewed. Some residents had two assessments of risk completed, these assessments diverged in their assessment of risk, one might show the resident to be at high risk of pressure ulceration whilst the other showed them to be at low risk. Where residents were assessed as being at high risk of pressure ulceration, some residents had Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 15 care plans to direct staff on how risk was to be reduced, but others did not. Some care plans relating to risks of pressure damage were clear, but others were not. For example, some care plans did not state how often a person needed their position to be changed, others did not document the equipment to be used, using general terms such as “pressure relieving equipment”, others did not document why a high specification mattress was being used when a lower specification cushion was being used in the person’s chair, even though the person sat out of bed all day. Turn charts were in place for some residents assessed as being at high risk of pressure ulceration. Other people did not have turn charts, although there were records to show that they were observed regularly during the 24 hour period. Where residents did have turn charts, some turn charts were fully completed and in accordance with care charts. Others showed long periods when a person did not have their position changed, although their care plan stated that they needed to have their position changed two hourly when sitting out of bed. On some occasions, it was observed that staff did move resident’s positions, when in sitting rooms, but omitted to document this care in the resident’s records. It is appreciated that no residents in the home had major pressure ulcers, however it was observed that at least three residents had minor pressure ulceration and a consistent approach is needed to the prevention of pressure ulceration, to ensure that any minor ulceration does not progress further. During the inspection, we observed nursing and care staff providing care in a range of settings. All observed care interactions were sensitive, patient and person-centred. Care plans highlighted people’s preferred forms of address. All staff were observed to consistently call residents by their own or preferred name. They included information about people’s former lifestyle and achievements. In people’s bedrooms and en-suites there was information to guide carers on how to make allowances for people’s specific sensory or mobility difficulties, in order to promote dignity, privacy and independence. Care plans included guidance on looking after people’s hearing aids and spectacles. A notice to staff in the sensory room reminded them of the “little things that can make a big difference” in promoting individual care. Staff knocked on doors and waited a reply before they went into a resident’s room. Where a resident was asleep, for example when sitting in a chair, staff were observed to gently wake them up before moving them, for example to assist them into a hoist before going to lunch. The laundress reported that whilst the issue of un-named clothes remained, that since the last inspection, this had reduced. One person’s care plan for medication use described ways of encouraging the person to take medicines. Their relatives and GP had signed consent to the use of covert administration when other strategies failed, but the care plan did not guide staff on what this was to mean in practice. This posed a risk of inconsistent practice, which might differ from the understanding of those who gave consent. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 16 Our Pharmacist Inspector looked at arrangements for the handling of medicines. All medicines are stored securely, however the space available to nurses when checking in or sorting medication is very limited. The controlled drug cupboard required the correct bolts to comply with current legislation. We observed a medication round on one floor. Nurses were seen to give medicines safely in accordance with good practice guidelines and take time with people who needed more attention. The nurse giving the medicines wore a tabard so that people were aware of the importance of allowing them to concentrate on the process. The medication administration records were clearly completed with the correct signature or code. The use of a separate sheet for the recording of creams was being considered by the home as this would improve the accuracy of the recoding of some external products. A homely remedy list had been approved by the GP for people to receive certain medicines without prescription; guidelines for their use were also available. Care plans that we saw showed guidance for the use of medicines prescribed ‘as required’ and risk assessments for people who were able to manage some of their medicines themselves. The appropriate oxygen warning sign had been removed at the time of the inspection, but this was replaced before we left the premises. A care plan was seen for one person who sometimes had their medicines crushed into soft food. The appropriate guidance and permissions had been obtained and recorded, but it would be good practice to check the individual medicines with a pharmacist to ensure their action is not compromised in any way. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents will be supported in exercising choice in their daily lives, with a wide range of individualised activities and wholesome meals provided in a supportive environment. EVIDENCE: Kings Court has put much effort into improving and developing its activities provision since the last inspection. Staffing levels have been increased, so that staff are able to support the activities staff. During the inspection, we observed that activities were taking place in all four of the sitting rooms. Some were larger group activities, others were smaller and included 1:1 activities. For example at 9:30am, a carer was supporting residents in one of the sitting rooms, playing soft foot-ball, encouraging residents to take part, ensuring that everyone there was engaged as much as possible. In another sitting room, later in the morning, three staff were observed to be engaging residents in armchair ballroom dancing, which everyone seemed to be enjoying, including the staff. One resident reported that they did “all such” activities, that they did exercises “every morning” and that it was always Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 18 “different” in the afternoon. Another resident reported that they were never bored “the days just seem to go so quickly”. The home employs two part-time activity co-ordinators. Between them, they were able to organise and oversee activity provision in the four units of the home, across the whole week. This was based on a daily programme, adjusted weekly. The activity co-ordinator on duty told us care and nursing staff were very supportive of residents’ involvement in activities, and we saw that this was so. With regard to those residents with dementia, she said the aim was to “find and engage with the individual inside”. Each morning, residents were invited to participate in gentle movement exercises. There was a lot of one-to-one staff availability to encourage people to join activities in the sitting rooms, whilst individual choices not to do so were respected. In the main dementia unit there was a sensory room, which was also being developed as a resource for arts and crafts. Activities included in the weekly programmes included music and exercise-based activities, hand care, ball and balloon games, bingo and watching films. Levels of participation were monitored, and people who preferred not to join group activities were given opportunities for one-to-one interaction. To facilitate this, the personal preference plan form could be expanded to gather information of people’s previous interests and activities. Residents had some opportunities for trips out, and some entertainments were brought into the home. As noted in Health and Personal care above, the home have set up individual profiles, which indicate a range of matters relating to each individual. Whilst these document details about their present needs and family history, not all document what their past interests were and this is recommended, to ensure that such needs can be considered when planning care. Senior staff reported that they had put much effort into ensuring that residents were able to exercise choice. This was reflected by records and what staff told us. One resident told us that they preferred to stay in bed and that this was respected. Another resident’s records showed, and staff told us, that they did not like a noisy atmosphere and so they ate in their room, where it was quieter. Care plans reflected individual differences. For example one person considered in detail was under 60. Their records took this into account, when documenting what they wanted to do and how they wished to spend their days. Information for residents in communal rooms has improved. At the last inspection, menus and information in dining rooms related to a few days previously. At this inspection, all such information was up-to-date and significant details such as the type of weather outside had been included and that the day was Ash Wednesday A review of the visitors book indicated that relatives and friends regularly visited the home. We met with one relative who reported that they felt able to visit their relative as regularly as they wished to. Another relative was Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 19 observed to come in at the mealtime, so that they could assist the resident to eat their meal. At the last inspection, which was only six months ago, we considered meals in detail and the inspection showed that all standards relating to menus and meal preparation were met. Questionnaires received before this inspection indicated a general satisfaction with meals provision. One person reported “my [relative] eats well and enjoys their food” and another described the meals as “quite reasonable”. One resident commented during the inspection “the foods alright – yeh” and another “the meals are good, you more-or-less have what you want”. The home’s chef is currently on maternity leave and a new chef has been appointed in her absence. He had been in post for two weeks when we inspected. This person is experienced in providing meals to elderly and frail people and was keen to further extend meals provision. He reported that he would be reviewing the menus shortly. He also reported that when he had been in post for a longer period, he planned to come and observe how meals were conducted. All meals are prepared from raw ingredients, including soups, gravies and sauces from raw ingredients. Snacks are provided in the kitchenettes and the nurse in charge has access to the kitchen out of catering hours, if a resident would like something that was not available in the kitchenette. We observed mealtimes across the home. Mealtimes appeared to be planned and well organised with staff showing no signs of needing to rush. On the ground floor, staff reported that now there were more staff on duty at mealtimes, it helped them to make sure that mealtimes were managed in a relaxed manner. Staff knew what residents liked and preferred. One carer discussed a resident who they reported often would not eat their main meal at lunch, although they liked their dessert. They reported that the resident did like breakfast, so they gave them extra at breakfast, to ensure that they did not become nutritionally compromised. Many residents were unable to give themselves meals, where this was the case, staff sat with them, supporting them to eat. A choice of different fluids was offered at mealtimes and jugs of water had been left in all residents’ bedrooms. On the dementia care units, arrangements for people to eat meals were also individual. We saw some people sharing dining tables and some being served in their rooms, or with an over-knee table in a sitting room. People with dementia were assisted to understand the context of their meal. Meals were presented attractively on plates. People with sight or other difficulties had eating aids. Staff provided non-intrusive assistance where it was needed, along with encouragement to eat and drink, in line with care plans. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents will be supported by systems which protect them from abuse and where their concerns and complaints will be considered. EVIDENCE: Kings Court has a complaints procedure, which is displayed and is also available to everyone in their rooms in the service users’ guide. Of the 11 people who responded to us in questionnaires, nine reported that they knew how to make a complaint. One person reported to us that if they were not happy they would “tell one of the girls and they would tell the boss and sort it out”, another “NO matters are ever ignored” and another person when asked if they knew how to make a complaint reported emphatically “I do”. One relative commented “I know who to speak to, and the problem is usually solved immediately”. The home maintains a log of formal complaints made to them. At the previous inspection, we were made aware that some people felt that they had raised matters of concern but this had not been included in the log. At this inspection, we noted that one person was documented as making a complaint during a social care review but this had not been included in the log. This related to the period before the current management took over the home. Other people, as documented above, considered that they have raised issues, Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 21 this may also relate to before the current management arrangements were put in place. We are aware that since the last inspection, an individual raised a formal complaint in writing with the provider about service provision. The initial response by the provider did not consider all the matters raised. The new management team have now re-opened the matter and investigated all areas, responding to the individual. Understanding the importance of informing management of complaints and ensuring that issues are addressed is an area that may need further development for some staff, although others will be fully aware of their responsibilities. It is advisable that all staff receive support in understanding the importance of ensuring that management are aware of issues raised by people. The home have put much work into ensuring that staff are aware of their responsibilities under safeguarding adults. We are aware that the home have raised matters in support of vulnerable persons through appropriate channels. We are also aware that the previous managers may have needed some support to be fully aware of the range of matters that may need to be considered when assessing if a matter needs to be referred as a safeguarding matter. We discussed safeguarding with staff who may be in charge of the home and they reported that they would refer safeguarding matters on to a senior manager within the organisation. This may not be possible at all times, if a relevant person is not available. It is therefore advisable that all relevant senior staff from the provider and staff who may be in charge of the home, receive training in the local procedures, so that they are confident in the actions to take under local procedures, to ensure that vulnerable people are safeguarded. Sometimes care planning and risk assessment led to strategies that kept people safe but also had restrictive implications. For example, a stair gate might be used across a bedroom doorway, or rails on the side of a bed. Care plans noted the importance of explaining such decisions to people’s relatives and securing their agreement, but this was not always followed through. It is important to demonstrate that such decisions about the resident’s best interest are shared. At the last inspection, issues relating to protecting residents who may be vulnerable to abuse from other residents, particularly on the dementia care unit, were identified. Discussions with staff, reviews of records and observations of care indicated that issues relating to possible aggression between residents has much reduced since the last inspection. This may relate to a range of matters, but particularly to the increased resident staff ratio, improvements in the home environment and training of staff in the principals of dementia care. The providers are to be congratulated for the efforts they have put in to ensuring that outcomes are improved for residents in this area. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider has made many improvements to the home environment and practice in the prevention of spread of infection, so that residents will now be cared for in a homely, comfortable and safe environment. EVIDENCE: The provider has made a major investment in the home environment since the last inspection. One relative described the home as “a pleasure to visit” another commented, “recently beautifully redecorated” and one resident commented, “its very comfortable here”. All corridors have been redecorated in attractive colours and new carpets are on order. Lighting levels in corridors have been improved to make them much lighter. All this makes corridors seem to be much wider and less closed-in. In the dementia units, advice had been obtained about current best practice in creating a comfortable and safe Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 23 environment that people could relate to. Bedroom doors across the home were painted in different colours to aid recognition. They had brass numbers and false letter boxes, to emphasise they were private spaces. Some doors, for example to cupboards, were disguised so people would be less likely to try opening them. There was use of pictures to help people identify toilets and bathrooms. The shower rooms have been fully up-graded, holes in walls have been repaired and they have been re-tiled. The providers have made a major investment in provision of furniture and none of the chairs or furniture reviewed was threadbare or showed holes in their fabric. It was reported that more new furniture was on order. Other items are in the process of being purchased, such as wheelchairs, protectors for safety rails and Kylie sheets Each unit had a maintenance book in which staff notified faults for the attention of the handyman. These showed that staff were alert to matters needing attention, and that notified faults received prompt attention. We noted that there was a significant gap between the flooring and skirting in a kitchenette and in a bathroom. These were evident potential dirt traps and should be sealed.. The provider is aware that some areas still need to be addressed, such as up-grading sluice rooms and cleaners cupboards there are plans in place to address these areas. The provider is fully aware that there are issues relating to egress of water into the lower ground floor. They have submitted an action plan to us about this area. There are now no risks to residents presented by this area, as the hairdressing room has been moved to a room on the ground floor. This new facility presents a light, attractive area, where people can feel as if they are attending a normal hair dressing saloon. One resident’s relative reported to us that of all the recent changes in the home, they “especially liked the hairdressing room up-stairs.” Cleanliness has much improved in the home. Standards of cleaning were high in public and private areas, including en-suites, where there were daily cleaning checklists. All of the support kitchenette areas are now clean and food items are safely labelled and stored. Kitchenettes contained trays of clean crockery for visitors to use. The kitchenettes were kept closed by high bolts, as a safety measure to ensure people with dementia did not enter them. We noted as good practice that whilst debris could be felt under dining room tables at the beginning of the inspection, once the cleaners had been in the room during the course of their duties, that debris had been fully removed. Items such as hoists and commodes were clean. We observed that senior domestic staff closely supported and supervised more junior staff, to ensure that their roles were correctly performed. For example, one senior domestic staff was speaking to another in their own language and the senior staff reported that this was to ensure that the more junior person fully understood the actions that they needed to take, to ensure cleanliness of the area they were working on. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 24 Some residents are prescribed or chose to use topical applications. Some of the jars of such creams were labelled with the person’s, name but not all. Jars of topical applications should always be labelled with the person’s name as otherwise there is a risk that such items may be used communally, particularly if they are left in a communal bathroom by mistake. We met with the laundress who reported that they were aware that the laundry was to be up-graded as part of improvements to the home. All of the laundry was dust-free, including behind the dryers. The laundress reported that since the last inspection, staff are separating laundry at source, so she does not need to re-sort laundry. She reported that staff performance has much improved in ensuring that they put infected and potentially infected laundry in alginate bags, however she still has occasions when staff did not do so. She reported that she felt able to bring this up with management and that action would be taken to ensure that staff were informed of the risks of not handling laundry correctly. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents will be fully supported by the numbers of staff on duty, who have been safely recruited and who are trained to perform their role. EVIDENCE: Since the last inspection, the provider has undertaken a full review of staffing levels, taking into account the dependency needs of residents. Following this, they have increased care staffing levels and activities staff. Staff at all levels said this increase had led to significant easing of pressure on them, particularly they had time to support residents individually and to be involved with the activities programme. Staff commented to us on how this increase in staff had supported them in their role. One commented how much easier it was to meet residents’ needs at lunchtime, another that “you can sit and talk to them now” about providing care to residents, another “you can now take time, find things out about people and what they want” and another that it was much easier to induct new members of staff into their role. Residents commented on staff availability. One reported “if I ring my bell, they come” and another “they come quickly to help”. One relative commented how much they liked having more staff because you could get hold of them quickly if their relative needed help. One person described staff as “cheerful Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 26 and helpful”. We observed that staff had time to support residents in activities and the standards of record keeping had improved, as staff had more time to complete necessary documentation. At the previous inspection, we considered recruitment and training records both of which indicated that our Regulations had been met in full. However during that inspection, we did identify that whilst training records were clear, it appeared that the training materials used, for example in dementia care, were not in sufficient detail to provide staff with an adequate knowledge base to meet residents’ needs. Since then all staff have undertaken an accredited dementia training course, “Yesterday, today & tomorrow”. Together with regular supervision, this meant there was a strong sense of teamwork and shared purpose among the staff group. Staff spoken with reported on how helpful they had found recent training in meeting the needs of residents with dementia. Staff spoken with were also aware that more training was being planned in the future. One area, which Health and Personal care above indicates needs further training is in the prevention of pressure ulceration, so that all staff are aware of the need for a consistent approach, particularly clear and accurate documentation. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents will be safeguarded by the management systems in the home, which support reviews of quality of service provision and up-hold the principals of health and safety. EVIDENCE: The former registered manager has left since the last inspection. The operations manager reported that a recruitment process had taken place and a successful appointment had been made. Currently the providers are waiting for the applicant to complete their notice period from the previous employers. The operations manager is supporting the home two days a week and an experienced manager from another home, one day a week. At the time of the Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 28 inspection the deputy manger, who had been acting into the manager’s role was on planned short-term sick leave. Since the last inspection, other management changes have occurred within the providers’ organisation. We are aware that the responsible individual for the home has changed, as has the operations manager who has more direct responsibility for overseeing the management of the home. This new operations manager took over responsibility for the home in mid-January. Staff we met with were fully aware of who to go to if they had issues and how they could seek support. There was no impression from what we observed that management systems had in any way deteriorated, despite all the changes that staff had faced. Some people commented particularly on how supportive the administrator was, describing them as “excellent with advice and help with any problems in admin”. The providers have submitted very detailed improvement plans to us since the last inspection and evidence from this inspection shows that they have kept to the plan, making significant improvements, within timescales. Changes made have been sustained. Where the new operations director has needed to approach us to inform us of matters, she has done so. We discussed supports for new members of staff with more senior staff. One senior carer was able to describe in detail how she supported newly employed members of staff, making sure they did not work unsupervised until they were competent. She also showed a sympathetic awareness of how complex it must be for a person who has not been a carer before or who has come from another country where their first language is not English, when they start work in a home which cares for people with dementia care needs. Care assistants were supervised by the nursing staff. Supervision arrangements were planned in advance at two-monthly intervals. We saw that staff were asked to prepare for supervision by considering a set topic. The process enhanced motivation to provide person-centred care. Staff discussed personal developmental issues, and the needs of residents to whom they were key workers. Supervisions were recorded. A care assistant told us they regarded supervision as a “top-up” to training, to maintain good practice. The provider has standard systems for ensuring that effective maintenance takes place on services and equipment such as boilers, lifts and hoists to aid manual handling. Records of maintenance are maintained. Training records showed at the last inspection that staff were trained in areas relating to health and safety. During this inspection, we observed several occasions when staff used hoists to aid manual handling. We observed that manual handling was carried out by at least two people and where there was increased risk, with three. We observed that staff worked well as a team, reassuring the resident and explaining what they were doing. They also talked to and observed each other, to ensure that the procedure was carried out in a safe manner. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 x x x x 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x 3 x 3 Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12(1)(a) Requirement Timescale for action 31/05/09 2. OP9 13(2) The home must improve its systems for the management of prevention of pressure ulceration, to ensure that: - all residents are assessed for risk, - where a risk is identified a care plan is always put in place, - care plans are completed to the same standards, to clearly direct staff on actions to take to prevent risk of pressure ulceration, - turn charts are in place where indicated - turn charts provide evidence that care is being given in accordance with care plans. The controlled drug cupboard 30/06/09 must be secured to a solid wall with rag or rawl bolts to ensure that it complies with current legislation. Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3. 4. 5. 6. Refer to Standard OP1 OP7 OP8 OP8 OP8 OP9 Good Practice Recommendations Accessible information be provided on the home for people with dementia care needs. All records relating to nursing and care need to be signed and dated by the person drawing up the document. Care records should clearly describe actions to take and care needs precisely. Where actions are identified there should be written evidence that they have taken place. All parts of care plans should be regularly evaluated. Where residents fluid intake is being monitored, all fluids given to people, including sips, should be monitored. Consideration should be given to the storage of medicines in a suitable area where there is room for staff to work safely with all the medication that is delivered to the home. The use of a separate recording sheet for some external preparations would allow a more accurate record to be kept. All medicines which are crushed or altered in any way should be checked by a pharmacist to ensure they are not affected by the process. Residents’ past interests should be documented in their personal profiles together with information on where information was obtained from. Staff should be supported in ensuring that all complaints raised by people are reported to management. All staff who may be in charge of the home should receive training in their responsibilities in the event of a safeguarding allegation. Any gaps between flooring and skirtings should be sealed to prevent potential dirt traps. All topical applications should be labelled with the person’s name. All nursing and care staff should be trained in the prevention of pressure ulceration and the importance of documentation in this field. The home should consider further systems to ensure that all residents have their clothes named. 7. 8. 9. 10. 11. 12. 13. 14. 15. OP9 OP9 OP12 OP16 OP18 OP19 OP26 OP30 OP33 Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 32 Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kings Court Care Centre DS0000015920.V373280.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!