Care Home: Kingsmead Care Home

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What the care home does well Kingsmead has a manager who has been in post for a period of time, who is experienced in their role and who can provide stability to the staff team. She is supported by a senior manager who visits the service regularly and is able to provide active support to the manager. This person completes detailed reports on the home`s care provision. These reflected what we observed and what we were told. We therefore felt that the provider was in a position to ensure effective service provision. A new deputy manager had recently been appointed. This person has experience in the types of nursing and care provided by the home. Although they had not been in post for an extended period of time, they already showed a detailed knowledge of the needs of the residents in the area of the home where they were working. They were also able to report on the supports they planned to give to staff, appreciating that caring for people with complex dementia care needs could be not easy for staff, particularly when they commenced their role. Despite the home needing to use agency staff, none of the residents we met with on the dementia care unit reported that this was of concern to them. One person reported "when I ask if I can do something, they say yes I can do it" and another "we`ve got lovely staff here". Records for one person who showed complex behaviours documented that they were supported by staff in going out into the home`s garden under supervision when they needed to. We observed that staff consistently called residents by their own preferred name and always knocked on residents` doors prior to entering their room. Two of the permanent carers told us how much they enjoyed working on the dementia care unit and of the supports they received from senior management. Considering the difficulties the home has had with staffing and the need for agency staff, it is much to their credit that assessments, care plans and records of care provided on the dementia care unit were up-to-date, with evidence of review, both regularly and when indicated. Care plans relating to behaviours exhibited by residents were clear and written in a non-judgemental style. For example one resident who showed highly complex behaviours had a clear care plan which directed staff to support the resident by giving them a cup or tea, which they enjoyed and talking quietly to them, removing them from the situation which was challenging them and while it did clearly direct staff on the drugsto be used if the resident put themselves at risk, it was clear this this was to be the last, not first resort. Another resident had a clear care plan about actions to take in a medical emergency, which staff we spoke with knew about. Residents` rooms were individual in style, reflecting the person`s likes and preferences. One resident was able to inform us of the new furniture which was on order for them to improve their room. Another resident told us about how good the cleaners were. All areas we inspected were clean and free of dust. There were no odours in the dementia care unit; this was despite many of the residents experiencing complex needs in relation to continence care. The manager is keen to support residents and their relatives. A resident reported to us on how their next of kin had raised matters with the manager and that she had taken action. Where the manager did respond to complainants, her letters were balanced in approach and the file showed full evidence of investigations. Residents also told us that other staff were supportive to them. A resident reported to us on their good rapport with a senior carer, reporting "you can rely on her". What the care home could do better: Some developments are indicated in the management of medicines. Improvements should be made to the system for ordering medicines to ensure that the correct prescribed medicines are always available. Clear guidance should be available to staff about the use of medicines prescribed to be given "when required" so that these medicines are given appropriately and consistently. If medicines are prescribed with a variable dose, the amount given must be recorded. So that it is clear how much medicine the person has had. Some records would benefit from improvement, this was particularly on the residential unit. A resident on the dementia care unit had a range of assessments, care plans and records of daily care, which were completed in generalistic language. For example their care plan stated that they were to receive a bath "on a regular basis", without stating what this meant or the person`s preferences. Clear care plans are important to support staff, particularly when we visited, there was an agency carer allocated to provide care on the residential unit. The person`s daily records also included judgemental language, for example one stated "X moans a lot". This is inappropriate language to describe the reaction to care provision of a frail elderly person. Some records relating to personal care would benefit from improvement. One resident had a topical application and a mouthwash solution in their en-suite, but these were not referred to in their care plan. Records relating to participation in activities had not been completed since February or March 2010, two to three months before the inspection. Where a resident is not able to remember activities participated in, full records will inform staff and support the care plan evaluation process. One resident was known by staff to have fairly complex relationships with their family and friends, which staff we spoke with knew about. However as the home is using agency staff, who at times will be in charge of the home, it would support them if such complexities for a resident were fully documented, to ensure that agency registered nurses were fully able to support the resident. The home retains copies of agency staff time sheets and an allocation book, however asthese are on several different documents, audit is complex. We therefore felt that a dayby-day record of the full name, designation and agency employer should be kept, as happens in most homes generally on the off-duty record, to enable quick review when needed. Random inspection report Care homes for older people Name: Address: Kingsmead Care Home 63 Prospect Place Old Town Swindon Wiltshire SN1 3LJ two star good service 07/11/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susie Stratton Date: 1 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: Kingsmead Care Home 63 Prospect Place Old Town Swindon Wiltshire SN1 3LJ 01793422333 01793422666 kingsmead@fshc.co.uk www.fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Ms Christine Bassett Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: No more than 18 persons aged 45 years and over with a mental disorder or dementia may be accommodated at any one time. These service users must be accommodated on the first floor. No more than 18 service users in the category old age, not falling within any other Care Homes for Older People Page 2 of 14 care home 43 Over 65 18 0 18 25 18 1 18 0 category, may be in receipt of nursing care and must be accommodated on the ground floor The `Annex` area may not be used for service users in receipt of nursing care whether in the OP, MD, MD(E), DE or DE(E) categories The only service user who may be accommodated in the category LD is the male service user in the application dated 28 June 2005. The only service user who may be in receipt of nursing care, aged under 65, is the service user named in the application dated 16th December 2005. The staffing levels set out in the Staffing Notice issued by Wiltshire Health Authority on 26 September 2000 in regard to Kingsmead Nursing Home (registration number QD7 8E577) must be met at all times in respect of the service users accommodated on the ground floor The staffing levels set out in the Staffing Notice issued by Wiltshire Health Authority under Sections 22(1) & 23(4) of the Registered Homes Act on 28 May 1999 in regard to Kingsmead Nursing Home (registration number QD7 - 8F177) must be met at all times in respect of the service users accommodated on the first floor Date of last inspection Brief description of the care home Kingsmead Nursing Home is situated in Old Town, Swindon and is close to local shops and bus routes. The home is a modern building on two floors and has accommodation for up to forty-three older people. It is split into three sections, comprising of a fivebedded residential unit, an eighteen-bedded nursing unit and an eighteen-bedded dementia/mental health unit. The accommodation comprises of a mixture of single and double rooms with some en suite facilities. Communal sitting and dining rooms are available and there is a safe, enclosed rear garden that contains a seating area. There are parking areas to the front and rear of the home. Kingsmead is part of the Four Seasons Healthcare group. Mrs Chris Bassett is the home manager, she leads a team of registered nurses, care assistants and anciliary staff. 0 7 1 1 2 0 0 8 Care Homes for Older People Page 3 of 14 What we found: This random inspection took place between 9:55am and 3:30pm on Tuesday 11th May 2010. The inspection was performed by a pharmacist inspector and a regulatory inspector. These people are referred to as we throughout the inspection as it was performed on behalf of the Care Quality Commission (CQC). We performed a random inspection because we had had two medication errors reported to us and also because some issues were identified during a multi-agency safeguarding investigation. The manager, Mrs Chris Bassett was present during the inspector and her manager made herself available towards the end of the inspection to receive feed-back about what we found. The pharmacist inspector looked at how medicines are looked after in the home. We spoke to two nurses involved in giving medicines and looked at arrangements for ordering, giving, and recording of medicines. We also looked at how medicines are stored in the home. People living in the home are registered with a number of different doctors practices. Staff order medicines from the doctor and the prescriptions go straight to the pharmacy to be dispensed. Medicines are supplied using a monthly blister pack system. Staff told us that they do not keep a record of the medicines they have ordered and do not see the doctors prescription. This means it is difficult to check that the correct medicines have been ordered and supplied. The Care Quality Commission have received two reports of people missing some of their medicines for several days. We also saw information in the home about some medicines which had been missing at the start of this months medicine cycle. Action must be taken to ensure that systems in place for ordering medicines are reliable so that prescribed medicines are always available. Records of medicines ordered should be available in the home so that staff can check that they have received the correct medicines. Staff told us that at present one person living in the home looks after a prescribed cream but all other medicines are looked after and given by staff. A small number of homely remedies are available for treating minor ailments, with a policy available for their safe use. We saw some medicines being given in the morning using a safe method. The manager told us that seven members of staff were due to attend a medicines training session from the pharmacy the following day. This helps to ensure that medicines are looked after safely. The pharmacy provides printed medicines administration record sheets for staff to complete when they have given medicines. We saw that these had been completed indicating that medicines had been given as prescribed. We looked at several blister packs and four standard packs, which indicated that medicines had been given as recorded. We saw that handwritten additions to the printed records were signed, dated and checked by a second person to reduce the risk of mistakes being made. Staff had rewritten one chart, which had been poorly written when a person first moved to the home, to make Care Homes for Older People Page 4 of 14 sure that the information was more accurate. We saw that two records where medicines had been prescribed with a variable dose but the amount given had not been recorded. When the dose of medicine to be given is variable staff must record the amount they have given, so that it is clear how much medicine the person has needed. We saw that several people were prescribed medicines to be given when required. Generally these were labelled with the dosage instructions but there was no indication of the reason for giving them. We saw that the downstairs nursing unit had protocols in place for many of these medicines to give information to staff about when these medicines should be given. We saw that these did not always cover all the medicines that had been prescribed when required and in particular did not cover medicines for emergency use in epilepsy. We checked three peoples care plans and found there was no information for staff about how the emergency treatment should be used. Protocols were not used on the nursing unit providing care for people with dementia so it was not clear how staff would know when to use these medicines. Action must be taken to ensure that there is clear information available about medicines prescribed to be given when required to ensure that these are given appropriately and consistently by all staff. Records are kept of the medicines received into the home. When medicines are brought in a weekly compliance aid, the contents of the box must be recorded so that there is a clear record of the medicines received. Records are kept of the medicines disposed of from the home. This means that there is a audit trail for the use of medicines in the home. Secure storage is available for medicines in the home. A locked cupboard should be used to store medicines awaiting disposal so that they are more secure. Medicines trolleys are used to transport medicines securely around the home. A suitable cupboard is available for controlled drugs, which need additional security. As discussed, action is still needed to attach the correct fitting to this. The manager agreed that this would be addressed as a matter of urgency. Records showed that these medicines have been looked after appropriately. Medicines fridges are available and records showed these are kept at suitable temperatures for safe storage of medicines. As issues relating to nursing and care provision had been raised only about the dementia care unit and the small residential unit, we concentrated on these areas when reviewing nursing and care provision. We met with and observed care for three residents on the dementia care unit and one resident on the residential care unit. We reviewed these residents records and discussed their nursing and care needs with three carers, an agency carer, a registered nurse and the deputy manager. We found that permanent staff knew and understood their residents care needs in detail. The agency carer reported that they had received a full handover when they came on duty and they knew how to contact senior staff if they felt they needed additional support. The deputy manager showed much insight into how the experience of living in a home could affect people with dementia. We looked at assessments, care plans and records relating to care provision for the three residents we met with on the dementia care unit. Records were completed in detail and reflected what staff told us. For example one resident had a wound, they had full records relating to the wound and their responses to treatment were regularly assessed. There Care Homes for Older People Page 5 of 14 was clear evidence that the tissue viability nurse had been contacted about the persons wound and their advice followed. The resident reported on the pain which they could experience, particularly when the wound was re-dressed. This was fully reflected in their care plan, with directions to staff on how the persons pain was to be minimised. Staff we spoke with were fully aware of how to reduce the residents experience of pain. A newly admitted resident had a full pre-admission assessment. Carers reported that they were informed about new residents need before admission. One resident had a preadmission assessment relating to a swallowing difficulty, their records showed that this assessment had been reviewed after admission and that the persons swallowing had improved after admission so that risk to them was reduced, enabling them to eat a normal diet. The resident was observed to eat the homes diet during the inspection, which they said to us that they enjoyed. The resident was clearly swallowing safely. Assessments, care plans and records of care provision on the residential unit were not so clear. For example the resident had a disability, which they knew about and were able to describe to us, telling us how it affected their life and the actions care staff needed to take to support them. The persons care plan was not clear and did not include any detail about how the resident needed to be supported, including what they described to us. Concerns had been raised with us about the homes staffing levels and high use of agency staff. The manager reported that the home had experienced problems recently with the recruitment of suitable staff and with staff absence. They reported that they were using agency registered nurses and carers at times.They reported and were able to show us that they were generally able to use the same agency staff to ensure consistency of approach for residents. They were able to show us the allocation list, which ensured continuity of care for residents. All agency staff had a standard induction when they commenced working in the home, which the individuals involved dated and signed. The manager also reported that the situation would be eased during the next few weeks, with the formal appointment of the deputy manager, with certain staff returning from periods of absence, including sick leave and that some people had also applied to work in the home. At the time of the inspection, there was no manager for the residential unit. The manager reported that several people had applied for the role and she would be intervieweing shortly. We looked at recruitment files for three members of staff. They all showed that the home had performed full recruitment procedures, in accordance with good practice guidelines. People had also raised issues with us about staff training. When we looked at staff training files we noted that while staff had been trained in mandatory areas such as fire safety and manual handling, there was little evidence of training in areas relating to resident care needs, such as dementia care and common conditions associated with elderly people, such as stroke care or diabetes management. The manager reported that this had been identified and the provider was currently supporting staff in working through their standard training programme on dementia care. This would be further progressed now that there was a deputy manager in post. Carers we spoke with were aware of the dementia care training programme and were keen to develop their skills in this area. They all reported that they felt supported by senior staff in the home. We looked at the homes complaints file and observed that the manager was keen to document and take action on any matters reported, which could affect a resident. This included small but significant matters for the resident, as well as formal complaints. For Care Homes for Older People Page 6 of 14 example, the record showed that a relative had raised concerns that their relative was not wearing their spectacles on day when they visited. The record showed that the manager had investigated the matter and had taken relevant action to ensure that the resident was correctly supported in the future. A review of staff files showed that the manager had had to take action in relation to certain member of staffs performance. The manager knew about the situation in detail, however certain matters relating to the situation had not been documented. It was reported that this was because the peoples roles had changed. We considered that the matter should still have been documented in relevant staff members files, as needs for supports in one area could also indicate that the person(s) involved might needs supports in other areas of their role. The home is visited by a senior manager from the provider on a monthly basis and a report made. Reports were clear and identified points for action as well as the homes strengths. The manager responded to the provider in wiriting about these reports, including action plans where appropriate. What the care home does well: Kingsmead has a manager who has been in post for a period of time, who is experienced in their role and who can provide stability to the staff team. She is supported by a senior manager who visits the service regularly and is able to provide active support to the manager. This person completes detailed reports on the homes care provision. These reflected what we observed and what we were told. We therefore felt that the provider was in a position to ensure effective service provision. A new deputy manager had recently been appointed. This person has experience in the types of nursing and care provided by the home. Although they had not been in post for an extended period of time, they already showed a detailed knowledge of the needs of the residents in the area of the home where they were working. They were also able to report on the supports they planned to give to staff, appreciating that caring for people with complex dementia care needs could be not easy for staff, particularly when they commenced their role. Despite the home needing to use agency staff, none of the residents we met with on the dementia care unit reported that this was of concern to them. One person reported when I ask if I can do something, they say yes I can do it and another weve got lovely staff here. Records for one person who showed complex behaviours documented that they were supported by staff in going out into the homes garden under supervision when they needed to. We observed that staff consistently called residents by their own preferred name and always knocked on residents doors prior to entering their room. Two of the permanent carers told us how much they enjoyed working on the dementia care unit and of the supports they received from senior management. Considering the difficulties the home has had with staffing and the need for agency staff, it is much to their credit that assessments, care plans and records of care provided on the dementia care unit were up-to-date, with evidence of review, both regularly and when indicated. Care plans relating to behaviours exhibited by residents were clear and written in a non-judgemental style. For example one resident who showed highly complex behaviours had a clear care plan which directed staff to support the resident by giving them a cup or tea, which they enjoyed and talking quietly to them, removing them from the situation which was challenging them and while it did clearly direct staff on the drugs Care Homes for Older People Page 7 of 14 to be used if the resident put themselves at risk, it was clear this this was to be the last, not first resort. Another resident had a clear care plan about actions to take in a medical emergency, which staff we spoke with knew about. Residents rooms were individual in style, reflecting the persons likes and preferences. One resident was able to inform us of the new furniture which was on order for them to improve their room. Another resident told us about how good the cleaners were. All areas we inspected were clean and free of dust. There were no odours in the dementia care unit; this was despite many of the residents experiencing complex needs in relation to continence care. The manager is keen to support residents and their relatives. A resident reported to us on how their next of kin had raised matters with the manager and that she had taken action. Where the manager did respond to complainants, her letters were balanced in approach and the file showed full evidence of investigations. Residents also told us that other staff were supportive to them. A resident reported to us on their good rapport with a senior carer, reporting you can rely on her. What they could do better: Some developments are indicated in the management of medicines. Improvements should be made to the system for ordering medicines to ensure that the correct prescribed medicines are always available. Clear guidance should be available to staff about the use of medicines prescribed to be given when required so that these medicines are given appropriately and consistently. If medicines are prescribed with a variable dose, the amount given must be recorded. So that it is clear how much medicine the person has had. Some records would benefit from improvement, this was particularly on the residential unit. A resident on the dementia care unit had a range of assessments, care plans and records of daily care, which were completed in generalistic language. For example their care plan stated that they were to receive a bath on a regular basis, without stating what this meant or the persons preferences. Clear care plans are important to support staff, particularly when we visited, there was an agency carer allocated to provide care on the residential unit. The persons daily records also included judgemental language, for example one stated X moans a lot. This is inappropriate language to describe the reaction to care provision of a frail elderly person. Some records relating to personal care would benefit from improvement. One resident had a topical application and a mouthwash solution in their en-suite, but these were not referred to in their care plan. Records relating to participation in activities had not been completed since February or March 2010, two to three months before the inspection. Where a resident is not able to remember activities participated in, full records will inform staff and support the care plan evaluation process. One resident was known by staff to have fairly complex relationships with their family and friends, which staff we spoke with knew about. However as the home is using agency staff, who at times will be in charge of the home, it would support them if such complexities for a resident were fully documented, to ensure that agency registered nurses were fully able to support the resident. The home retains copies of agency staff time sheets and an allocation book, however as Care Homes for Older People Page 8 of 14 these are on several different documents, audit is complex. We therefore felt that a dayby-day record of the full name, designation and agency employer should be kept, as happens in most homes generally on the off-duty record, to enable quick review when needed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 When medication is prescribed for use when required, as directed or with a variable dose, make sure there is always clear written direction to staff on how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This requirement was identified at the previous inspection. It has not been met in full. This is to help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned actions. 01/01/2009 2 26 13 A policy and procedure on 31/12/2008 management of sanitary items must be developed for the area of the home without a sluice room. Not reviewed at this inspection. If clear systems are not in place in relation to cleansing sanitary items in homes, Care Homes for Older People Page 10 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action there is a risk to cross infection. Care Homes for Older People Page 11 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Full care plans must be developed for people on the residential unit, together with records of care provided. This is to ensure that all staff, including agency staff, are advised of how to meet individuals needs. Records of care given will support evaluation of care plans. 30/07/2010 2 9 13 Action must be taken to 15/06/2010 ensure that reliable systems are in place for ordering medicines and that records of medicines ordered are available in the home. This is to ensure that the correct, prescribed medicines are always available. Care Homes for Older People Page 12 of 14 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 2 3 7 7 9 Care plans should always include information on application of topical creams and use of mouth washes. Judemental language should not be used when describing responces to care provision. If medicines are prescribed with a variable dose, the amount given should be recorded, so that it is clear how much medicine the person has had. All activities participated in by residents should be documented. Written information relating to known supports for residents from family and friends should be completed in full. Records relating to staff performance and supervisions should be made, even if a member of staff has ceased to perform that particular part of their role. Records of agency staffs full name, designation and agency employed by should be maintained on a daily basis on a record such as the off-duty record. 4 5 12 13 6 37 7 37 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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