Care Home: Kings Lodge

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What the care home does well People using the service are afforded the right to privacy and dignity by a staff team that are very dedicated to their work and consistent in their approach. People using the service are supported to maintain as much of their independence with choices being an integral part of the service. The service is run in the bets interests of people living at Kings Lodge. The loyal staff team were knowledgeable about the needs of people using the service and demonstrated that they had a good understanding of the homes policies, procedures and good practice. A staff team that has been appointed through a robust recruitment and selection process supports people living at the home. There is a range of activities/facilities available for people using the service to join in with. The home is maintained to a good standard with a range of communal areas to choose from and gardens to use when the weather permits. What has improved since the last inspection? A review of how medication is administered at the home has been completed and evidence confirms that the system is managed safely. Staffing levels are good and are meeting assessed needs. What the care home could do better: Health and Safety records must be available for inspection. A health and safety monitoring systems needs to be developed as past of the regulation 26 visits performed by the provider. Key inspection report Care homes for older people Name: Address: Kings Lodge 50 North End Higham Ferrers Northants NN10 8JB     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: Judith Roan     Date: 1 8 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Kings Lodge 50 North End Higham Ferrers Northants NN10 8JB 01933315321 01992710401 info@windmillbanks.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Claude Fonseka,Mrs Viola Fonseka Name of registered manager (if applicable) Mrs Kathleen Elizabeth Murphy Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability Additional conditions: A named service user within the category of LD may be admitted to the home for a period of not more than 6 weeks. No person within the category DE(E) can be admitted where there are already 21 persons of category DE(E) already in the home. Date of last inspection Brief description of the care home Kings Lodge provides personal care and support for up to 21 people over the age of 65 years who have a dementia related condition. The home is situated on the outskirts of Higham Ferrers, with public transport links to neighbouring towns. The home is a conversion of a large residential property, with 2 larger communal lounges and 2 smaller sitting rooms. Bedrooms are located on the ground and first floors and a shaft lift provides access to the first floor. There is a garden at the rear of the property, Care Homes for Older People Page 4 of 26 Over 65 21 0 0 1 2 9 0 9 2 0 0 8 Brief description of the care home which contains an aviary. The home has been in the hands of the current owners since 2004. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Care Quality Commission(CQC) is upon outcomes for people who use the service and their views of the service provided. This process considers the services capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was case tracking which involved selecting two people who use the service and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. The homes registered manager also completed an Annual Quality Assurance Assessment (AQAA) a questionnaire required to be completed by CQC which was sent as requested. We also received surveys from people whop use the service, relatives Care Homes for Older People Page 6 of 26 and health care professionals. The inspection was unannounced and was undertaken during the morning and afternoon. The homes policies, procedures and records in relation to staffing recruitment and training, concerns and complaints, medication management, and general maintenance and upkeep of the home were viewed. The fees are available form the homes manager on request. People using the service said: I feel very safe living here My room is comfortable. There is a good choice of meals and I enjoy the meals. They look after me well Relatives said: A relative asked at the time of the inspection said that there had been a good admission process for their family member and that the support had been good. Comments made in surveys We are always kept informed I am quite happy with my relatives care Meals are plentiful and various Staff are always pleasant and spend time with my relative Good personal care and monitor their health The service has improved so much in terms of decor, cleanliness and socialisation of residents My relative is more settled and content than they have been for several years Friendly and accommodating Health care professional said The service is always looking to improve The look after people well Staff said. We provide a caring home for service users so that they can enjoy day to day living safely Could provide more activities outside the home Information is always good The induction training was done very well I receive regular support from my manager The home is run well I enjoy working at the home as we work as a team Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 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 26 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. Good information and pre-admission assessments ensure that the personal care needs of peoples using the service can be met. Evidence: Copies of the statement of purpose and service users guide are available within the and provided to all people considering the service and their families. New residents and their families can visit the home prior to admission and their try out the service. On speaking with a relative they confirmed that they had been given good and extensive information about the home prior to their family members admission. In discussion with a new residents relative they said that We were shown around the home and given an opportunity to meet everyone. In reviewing the care files an assessment of need was undertaken prior to admission gaining information about their needs and social history. The care files also contained signed contracts. To improve the service it is recommended that within the contract Care Homes for Older People Page 10 of 26 Evidence: an additional sentence is included to confirm that the service users guide and complaints procedure have been received. Care Homes for Older People Page 11 of 26 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. People who use the service can expect that their health and personal care needs will be met. Evidence: The care plans of two people that use the service were case tracked. Plans are developed from the assessments of need undertaken on admission and or via the review process used within the service. Preferences in relation to gender of the carer to support with personal care is promoted and respected. Evidence was found on files that plans are reviewed monthly or more often as required. Care plans are supported by risk assessments. Care plans could be made more person centred by writing them in the first person as if the individual had written their own plan. All care plans include sections for a Waterlow score (pressure area care need), nutrition manual handling and falls risk assessment. It is evident that health care needs are met by having a positive working relationship with local healthcare professionals who visit people at the home at an individuals Care Homes for Older People Page 12 of 26 Evidence: request or when a staff member has identified concerns/needs. Requirements in relation to medication made at the random inspection have been reviewed and there is positive evidence that the system used is safe. All staff administering medication are fully trained. Medication profiles are in place and checks concluded that management of medication was safe and in accordance with the Royal pharmaceutical society guidelines. In observation of care practices during the inspection carers were seen to be respectful in their approach and supported people to maintain their dignity by being discreet in how they spoke to people when personal care was being offered. In speaking with people that use the service they all commented that the staff were good and respected their privacy. Staff were fully aware of the needs of people they supported and aware of good practice in relation to personal care. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have a choice of activities that leads to a contented lifestyle. Evidence: There is a range of activities promoted within the home which people using the service can choose to join in with. In talking to people throughout the inspection they said that they could choose to take part in the activities which they enjoyed. The AQAA confirms that since the activities organiser left A member of staff has been asked to organise and co-ordinate daily activities for the service users. All service users are encouraged to participate in the activities that take place daily. Activities take place in the main lounge which is spacious and the service users able to socialise well. Some of the completed work from the activities can be seen on the notice board. On occasions ie birthdays, Christmas, easter we have themed events for the service users where we hold raffles etc to add variety to the activities for the our service users. A large sensory stimulating garden at the back gives the service users the opportunity to enjoy the outdoors where they are free to explore and enjoy on their own if they wish. The Church service from Higham Ferrers visits the home once a month to conduct various church services. Up to date information is provided on the activities notice board for the service users to see and select.. Care Homes for Older People Page 14 of 26 Evidence: Families are always welcome into the home and often called several times a week. Some family members visited daily. In discussion with one relative they said that their family member was happy at the home and there was always something to do. A healthy menu is available to people that use the service. Breakfast is served to people using the service in the dining room or on a tray in their room. The dining room areas are at each end of the lounge which provides for smaller group dining, A member of the staff team cooks fresh meals each day. There is always a cooked meal at lunchtime with an alternative if they do not wish to have the course offered. There is good domestic routine in place within the kitchen to ensure that food hygiene practices are maintained. Families who returned the surveys were very positive about the improvements made at the home and was happy with their care. Another felt that the service could provide more trips out which the manager is aware of and would like to do more of. The AQAA states that We are planning trips to the coast for the service users when the weather is warmer. Staff levels permitting it would be beneficial for service users to have 1-1 activities for those not prepared to join in group activities. Care Homes for Older People Page 15 of 26 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. Practices within the service protect people who use the service and ensure that they are listened to. Evidence: People spoken with said that they felt safe living at Kings Lodge. People were clear about who do speak to if they had a concern or felt that they were not being treated appropriately. Carers also said that they would report any concerns and knew that there is a whistle blowing policy in operation at the home. A complaints policy and procedure is in operation at the home and the registered manager is proactive in this area and states in the AQAA All complaints are investigated and actions taken promptly to address the issues efficiently and are recorded accurately. Appropriate action is taken to ensure that there is no repetition of any incidents through staff awareness of the issues concerned. We have a culture of pro-action than reaction to ensure that there is no need for any complaints in the first place. All service users and relatives are aware of our complaints procedure and have easy access to forms on which to make the complaint. These are kept in the reception area and are easily accessible. All contact details of where to send a complaint are on view on the notice board in the reception area. CQC has not received any complaints or concerns since the random inspection in September 2008. A safeguarding issue was investigated at this inspection but the Care Homes for Older People Page 16 of 26 Evidence: allegation was not substantiated. We did make a requirement for a review of the medication system, which has been met. A recommendation to ensure that staffing levels meet the level of needs of people living at Kings Lodge has also been reviewed and met. The services recruitment systems ensures that staff working at the home are subject to robust employment checks, that include, employment history, references and criminal record disclosure checks. Staff have received training in safeguarding procedures and the manager has attended deprivation of liberty training. A copy of the local safeguarding protocols and procedures is held at the home. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The safety of the homes environment is being addressed and improvements made to the decor. Evidence: In touring the building all areas were seen to be clean, hygienic and being improved. several rooms have been redecorated as part of an ongoing programme. There has also been significant work undertaken to improve the fire safety systems at the home. The garden provides good outdoor space that people living at the home can enjoy when weather permits. The communal areas were clean and had homely touches. The communal areas facilitate the company of peers or quite areas where people can sit and enjoy quiet time. The manager within the AQAA supplied information prior to the inspection-taking place on the frequency of safety checks and the maintenance and upkeep of the home. On reviewing these at the home we found that the Gas Safety certificate was not available, but this has since been provided. Bedrooms contained personal items of furniture and electrical equipment such as TVs, Radios, CD players, personal paintings and photographs. Care Homes for Older People Page 18 of 26 Evidence: All of the bedrooms viewed were clean and hygienic. There are good infection control measures within the home with staff being aware of good practice in minimising the risks of cross infection. People living at the home and their relatives spoke of their satisfaction with their bedrooms saying how much they liked living at the home. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are safe as a result of the robust recruitment procedure and feel supported by the dedicated and competent staff team. Evidence: Kings Lodge has a thorough recruitment procedure and files seen confirmed that required employment checks, application form, two references, criminal records bureau disclosures and interviews have taken place. The staff team have a sound knowledge base about the needs of people that use the service. Through observation during the inspection they showed that they had a range of skills to support individuals and were proactive in maintaining everyday living skills. Carers are offered a range of opportunities to train. Of the staff team 64 percent of staff team have achieved National Vocational Qualification at level two or above with the remaining staff undertaking the training. This is above the required minimum standards of fifty percent of staff being qualified. Carers spoken to had a good knowledge of the needs of people using the service and were committed to providing a good service. They felt supported and received formal regular supervision. Carers have access to a wide range of training topics that includes Health and safety, Fire, safety, Food Hygiene, infection control, safeguarding, healthy eating, activities for residents, and dementia awareness. Staff had also completed manual handling training with annual refresher training to maintain good practice. All new staff receive Care Homes for Older People Page 20 of 26 Evidence: Common Induction Standards training which is advised by Skills for Care. Care Homes for Older People Page 21 of 26 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 service is managed in the best interests of people living at the home. Evidence: The registered manager demonstrates their commitment to delivering a quality service for older people who use the service. They have completed the Leadership for Management in Care Services award and been successful in their application to become the registered manager through CQC. The manager maintain a professional relationship with CQC and has provided the data we asked for within the timescales. They also inform CQC as required of events that occur at the home. Staff have good support and confirmed the statement in the AQAA that Staff supervision is carried out every two months and includes all aspects of the practice, philosophy of care and career development. Staff are also offered 1-1 guidance and support when finding any aspect of their job role difficult. The surveys also confirmed that the staff team felt supported. Care Homes for Older People Page 22 of 26 Evidence: Staff meetings are held on a frequent basis to discuss practice issues and these are recorded. Essential information about the care of people using the service is handed over at the change of shifts and in communication system at the home. All staff are aware of the importance to maintain good communication and confidentiality within the home. The staff rota is developed to ensure that there is a balance between direct work with people using the service and administrative tasks. The home does hold some monies of behalf of people using the service but in the main relatives continue to provide this support. Where the home staff are involved there are safe systems in place to manage the finances for individuals. There is a quality assurance system in place with the use of surveys twice a year. This was confirmed by relatives in surveys and in the AQAA Feedback is actively sought so that we can deal with areas that can be improved on. Customer Feedback evaluations are given to the service users and their relatives to ensure that they are happy with the quality of our services twice yearly. The quality assurance system could be further developed by seeking the views of others like staff, healthcare professionals involved within the home. The outcomes of these could be produced in an annual development report for the service. Care Homes for Older People Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 15 Records relating to the 30/10/2009 maintenance of heating equipment must be available for inspection at all times. This is to ensure people living at the home are protected and safety systems are monitored. 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 33 The quality assurance system could be further developed by seeking the views of others like staff, healthcare professionals involved within the home. The outcomes of these could be produced in an annual development report for the service. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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