Care Home: Kingsmead Lodge

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What the care home does well Peoples` needs are assessed prior to admission to determine the suitability of placement. Systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the care when required.People who live in the home and their families are involved in this process wherever possible. Staff have a good awareness of individual needs and treat people in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. People receive a varied and wholesome diet that they are able to influence. The recruitment policies and procedures set up in the home should help ensure that people living in the home are supported and protected. The home encourages and supports staff with training in order for them to develop their knowledge so that they have the required skills to meet the needs of the people. What has improved since the last inspection? Safe, effective systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. The complaints policy and procedure in the home is effective and all concerns are taken seriously and acted upon efficiently. People can be sure that they will be listened to and that their thoughts and feelings are taken into account. What the care home could do better: Care plan details and the care file content and documentation has improved, however there needs to be more consistency in documenting peoples choice and preferences so that staff know how people living in the home wish to receive care and that they will be supported to live the lives they choose. Not all the people in the home benefit from a varied activities programme, which is enjoyable, stimulating and meets individual preferences and expectations. The home is clean and comfortable. Once the redecoration and refurbishment programme is completed it will provide a safe, peaceful and well maintained environment for the people living there. We are satisfied that the outcomes for people who use this service will improve and that people`s needs and best interests are central to the new management approach in the home. Some of the outcomes have been judged as adequate because they are either not fully met or because we need to be satisfied that the improvements made will be sustained.We have not made requirements as a result of this inspection because Mimosa have already identified where improvements need to be addressed and have already started to put some of their plans into practice. As a result of this inspection we request that Mimosa send us their improvement plan and subsequent action plan with timescales and we look forward to seeing the effectiveness of their plans during our next visit. Key inspection report Care homes for older people Name: Address: Kingsmead Lodge West Town Road Shirehampton Bristol BS11 9NJ     The quality rating for this care home is:   one star adequate 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: Wendy Kirby     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Kingsmead Lodge West Town Road Shirehampton Bristol BS11 9NJ 01179823299 01179824515 kingsmead@mimosahealthcare.com www.mimosahealthcare.com Mimosa Healthcare (No4) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 81 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: May accommodate 37 persons with Dementia, requiring nursing care on the ground floor (Kingfisher Unit) May accommodate 44 persons requiring nursing care on the first floor (Nightingale Unit) The maximum number of service users who can be accommodated is 81. 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) - maximum number of places 44 Dementia (Code DE) maximum number of places 37 Date of last inspection Care Homes for Older People 2 2 0 3 2 0 0 9 37 0 Over 65 0 44 Page 4 of 29 Brief description of the care home Kingsmead Lodge is a two-storey purpose built home, which provides general and specialist nursing care to older people and to those with Dementia. The staff team consists of nurses, which are supported by care staff who provides twenty-four hour care on a daily basis. The home has 81 places, which are divided over the two floors. Each floor is divided into two units, which can be identified as the Nightingale unit, which can be found upstairs and Kingfisher, which can be described as the Dementia unit and can be found on the ground floor. There are rooms available for single occupancy and some rooms are offered for those who wish to share. All the rooms have en-suite toilet facilities. The property has a tidy landscaped garden with a patio, which is accessible to the people who use the service. The property can be found in the village of Shirehampton in Bristol. There are local shops and supermarket with other facilities on offer in the community. There is access to the motorway and public transport available into Bristol City and its surrounding areas. The fees charged are dependant on an individuals care package. The weekly charges do not include, hairdressing, newspapers and magazines, chiropody or any personal toiletries. Care Homes for Older People Page 5 of 29 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: one star adequate 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: This was an unannounced Key Inspection which included a visit to the home. The visit was completed by one inspector over two days. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The previous inspection report. The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The Annual Quality Assurance Assessment, known as an AQAA. The home is requested annually to complete and return this assessment to us by a specified time. We received the AQAA on time, which contained information about what the home considers it does Care Homes for Older People Page 6 of 29 well and what plans they have for further improvements in the coming year. We sent surveys Have Your Say to people who live in the home, staff and health and social care professionals. Comments received from the surveys will be referred to throughout this report. During our visit we spoke with some of the people who live in the home, visitors, the Director of Quality, the manager, and other staff members who were on duty. We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at eight individuals care files, which included, pre admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day to day running and management of the home. We spent time in all communal areas of the home and most of the bedrooms and bathrooms. Feedback was provided throughout the visit and at the end of the inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care plan details and the care file content and documentation has improved, however there needs to be more consistency in documenting peoples choice and preferences so that staff know how people living in the home wish to receive care and that they will be supported to live the lives they choose. Not all the people in the home benefit from a varied activities programme, which is enjoyable, stimulating and meets individual preferences and expectations. The home is clean and comfortable. Once the redecoration and refurbishment programme is completed it will provide a safe, peaceful and well maintained environment for the people living there. We are satisfied that the outcomes for people who use this service will improve and that peoples needs and best interests are central to the new management approach in the home. Some of the outcomes have been judged as adequate because they are either not fully met or because we need to be satisfied that the improvements made will be sustained. Care Homes for Older People Page 8 of 29 We have not made requirements as a result of this inspection because Mimosa have already identified where improvements need to be addressed and have already started to put some of their plans into practice. As a result of this inspection we request that Mimosa send us their improvement plan and subsequent action plan with timescales and we look forward to seeing the effectiveness of their plans during our next visit. 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 9 of 29 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 10 of 29 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. Peoples needs are assessed prior to admission to determine the suitability of placement. Evidence: We looked at the pre admission assessments, which were comprehensive covering all activities of daily living, a full health screen and personal history background. The format has been the modified to include sections that relate to The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The information gathered pre admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. People wishing to live in the home, family and carers are involved in the pre admission assessment wherever possible and all information is used to determine the suitability Care Homes for Older People Page 11 of 29 Evidence: of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other health and social care professionals involved, for example, social workers and hospital staff. The manager clearly demonstrated the importance of thorough pre-admission assessments in order to ensure that the home can meet individual needs. The Social and Health care professional surveys agreed that the care services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people living in the home. Care Homes for Older People Page 12 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been some steady progress made in the outcomes for people who use this service. These will need to be monitored by Mimosa and the manager to ensure that these improvements are sustained. There are safe systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. We saw some good practice by staff in promoting peoples privacy, dignity and respect. Evidence: From the pre admission assessments the staff are able to develop a set of care plans based on identified needs. During the first months trial period the plans are reviewed weekly and developed accordingly. Care plans were completed with regards to health and social needs including, psychological, emotional, and cultural needs which demonstrates that the home takes an holistic approach to the provision of care. Care Homes for Older People Page 13 of 29 Evidence: The plans that we looked at were fairly detailed and person centered but varied in quality and was dependent on who had written them. Some plans included personal preferences and like and dislikes. Some plans told us that people had specific requests and routines, this is very good practice and helps demonstrate that some people are involved in deciding how they wish to receive care. The plans showed consistency in assessing, planning and evaluating care as required. The manager has started auditing the care files and has identified areas that need improving, written feedback is given to staff including any further action required. Staff are going to receive additional training in person centered care planning and people who live in the home and families will be involved in this process. The AQAA tells us about how the home has improved over the past twelve months, Care planning and risk assessments have improved significantly in terms of detail and quality. Care plan training and more involvement of senior care assistants with record keeping takes place wherever possible. Staff have had training in care planning to make them more person centered taking into account equality and diversity, also dignity in care. Health care needs are monitored and documented in peoples care files. Nutritional assessments are completed on admission and reviewed monthly, people are weighed monthly as part of this review. Care plans are written for people who are nutritionally at risk and how this is to be managed. Specialist health care support is often sought and referrals are made to community dietitians and speech and language therapists. Monthly audits take place and and evidence shows that peoples weight has increased. We did see that several people were having their fluid and nutritional input recorded daily, however entries were inconsistent and the amounts were not totaled over a twenty four hour period. In order to identify whether people are at risk, the chart entries need to improve. A General Practitioners (GP) visits on request, all visits and the outcomes are recorded in peoples care file. Specialist referrals and visits from other professionals including, Chiropodists, Dentists and Opticians were also seen. Social and health care professional surveys told us that generally peoples social and health care needs are properly monitored, reviewed and met by the care service. They also said that the home usually seeks advice and acts on it to meet peoples needs in order to improve their well being. Comments included, Staff know the patients and can explain problems in physical, mental and emotional domains, If I make a request for action I Care Homes for Older People Page 14 of 29 Evidence: am confident that they will be done and We have just started regular weekly visits to the home. Systems and procedures have improved over the last few years. Policies and procedures for receiving, storing, administering and disposing of medications were examined and discussed. All systems in place are very effective, well managed and audited. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by a local pharmacist. Six monthly medication reviews for people living in the home are completed by GPs. Fridge temperatures are recorded daily, the administration charts were legible and continuity of administration was shown with a signature from the people dispensing. Following a requirement from the previous inspection storage facilities and medication procedures have improved. The AQAA tells us, There are two medication trolleys on the first floor and a large spacious one on the ground floor. Medication audits are carried out monthly and this has helped decrease the amount of medication stored at the home. PRN medication protocols are in place on both floors. The home promotes privacy and dignity to all people who use the home. Staff attend training on induction, which covers aspects such as closing doors and pulling curtains when delivering personal care and knocking on doors and waiting for an invitation to enter before going in to their bedrooms. We saw some evidence that privacy and dignity is respected, staff were knocking on peoples doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred, this information was also recorded in the care files. Although the home promotes privacy, dignity and respect, evidence in this report under the standards for the environment show that this is compromised by some of the poor quality found in the in the home. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the people in the home benefit from a varied activities programme, which is enjoyable, stimulating and meets individual preferences and expectations. People maintain family contact and staff encourage family and friends to join in with activities and any outings. Some evidence would suggest that the home actively promotes individuals to exercise choice and control over the lives they choose to live, however there is limited written documentation to support this. People receive a varied and wholesome diet that they are able to influence. Evidence: There does not appear to be any unnecessary rules in the home and it seemed that daily routines are flexible within the home. We saw some evidence that people can get up and go to bed when they like, have their meals in their bedrooms, and participate in activities they have a particular interest in. This was confirmed in discussion with individuals and through observation during our visit. Care Homes for Older People Page 16 of 29 Evidence: There is some information recorded about personal preferences; however this information is not available for all of the people living in the home. Because peoples wishes are not recorded in individuals care plans, people may not always have their choices respected. There is one full time activity coordinator to accommodate up to eighty one people when the home is occupied to full capacity. People at present are not always socially stimulated, individual preferences for activitys are not always recorded and current activitys do not meet expectations, preferences and individual capacity. One coordinator cannot meet individual choice for eighty one people. This is something that the manager has identified since her appointment in post. The manager and the Director of Quality for Mimosa told us that additional deployment for activitys would be addressed. People felt that people in the nursing unit received more stimulation through groups and one to one sessions compared to those in the dementia unit. We did not see any activity take place during our two day visit. Staff were doing their best to engage with people and we saw some people singing with staff. Time and care restraints means that staff are not able to provide this all the time and verbal interaction is limited. People told us that people living in the home are bored. Comments included, People are not kept occupied and stimulated, this can make people in the dementia unit very restless, If you look at the body language people are slumped in their chairs and often just sleep because there is nothing else to do and Because people dont have anything to do, they start to talk to each other just to get some sort of reaction or attention, unfortunately because they have dementia the understanding of the conversation is limited and this can lead to arguments amongst residents. Observation during our two day visit confirmed the above comments were true. Some people were asleep a lot of the time, some people looked distressed, lonely and anxious. Some people told us that they are content and take part in some of the activities provided, they also said that they preferred to stay in their rooms enjoying watching television, listening to music and reading. We were told that some entertainers visit the home throughout the year and children from a local school also visit on a regular basis. The home operates an open door policy for visitors and people are able to see visitors in the privacy of their own rooms and there are several semi private seating areas around the home and in the gardens. The home has a large welcoming reception area and a receptionist is available Monday Care Homes for Older People Page 17 of 29 Evidence: to Friday to greet and assist visitors. The size and layout of the dining room makes it possible for everyone to enjoy the social advantages of dining together. The dining room is light and spacious with good quality dining furniture. Staff members supported people that required assistance with eating their meals in a respectful sensitive manner. Staff sat at the same level and assisted them without rushing. We saw jugs of juices, beakers and glasses and these were being handed to people whilst waiting for lunch. Later when we visited people in their rooms we saw that jugs of fluid had also been provided for individual use. The food is home cooked offering various choices of hot and cold alternatives and fresh fruit is available at all times. The menus display traditional meals and menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. The AQAA tells us, Menus are discussed at residents meetings and suggestions and ideas are forwarded to the cook. The cook also receives likes and dislikes of all residents and monitors nutritional and cultural values. Families and friends are invited to have meals with their relative and special occasions such as birthdays, anniversaries can be catered for in the small lounge for families and is buffet provided. Care Homes for Older People Page 18 of 29 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. There are good policies and procedures in place to manage complaints and people can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. Evidence: Since the appointment of the new manager we saw evidence that complaints and concerns have reduced and that all concerns are dealt with effectively under the homes policies and procedures. We receive details from the home about any internal complaints investigations and safeguarding referrals, the outcomes we saw at the inspection show us that these have been dealt with openly and effectively. The manager is committed to encourage an open culture within the home so that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals. She makes every effort to see people living in the home Monday to Friday and her office is by the main reception area which means that visitors can see and talk to her on a regular basis. Being available has meant that people can discuss any concerns or issues with the manager before they potentially escalate into complaints. Holding meetings for people living in the home, relatives and staff will mean that communication and sharing information will improve. This further promotes people Care Homes for Older People Page 19 of 29 Evidence: becoming less frustrated, thus relieving anxieties and any potential complaint referrals. Eight out of nine people living in the home stated in our surveys that they knew how to make a complaint and all nine told us that they could speak with someone in the home if they were not happy. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. We were told that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis the staff receive an update. Policies and procedures given to staff include, Whistlblowing, How to make a grievance and Harassment in the workplace. During the inspection some staff told us about a recent incident in the home involving staff members on duty. It was evident that staff had not followed these policies and procedures and the incident had not been reported to the manager. We informed the manager and Director of Quality about the incident during the feedback session at the end of the inspection. We have since received information about the investigations that took place in order to follow up the alleged incident and we are satisfied with the outcomes. We are mindful that the frequent changes in management may compromise staff confidence in reporting incidences. A number of staff have either completed or are enrolled on the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Care Homes for Older People Page 20 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable. Once the redecoration and refurbishment programme is completed it will provide a safe, peaceful and well maintained environment for the people living there. Evidence: The home has a number of aids and adaptations throughout the premises to enable physically disabled people to maximise their independence. This includes wide corridors and pathways, passenger lifts, specialised bathing facilities, grab rails and assisted toilet facilities. We walked around the inside of the home and viewed most of the bedrooms and the communal areas including the dining rooms, lounges and bathrooms. Many of the communal lounges, dining rooms, hallways and corridors are due to be redecorated through the homes annual improvement plan. Bedroom sizes are quite spacious for their stated purpose and have en suite facilities provided, communal bathing areas, showers and toilet facilities are located throughout the home. People are supported to personalise their bedrooms with pictures and ornaments and they are able to bring items of furniture should they wish. Rooms are lockable so that they can maintain their privacy and keep their personal possessions secure. All rooms had profiling beds where required. People are provided with bedroom suites, lounge chairs and small tables. The quality Care Homes for Older People Page 21 of 29 Evidence: of theses items in many rooms was poor and broken. Draws would not shut and were left open, potentially people were at risk of receiving skin tears to their legs particularly those with dementia who have limited ability to assess risk. Some draws would not open without falling apart and some wardrobe doors were broken. The wardrobes were light in weight and it would be easy to pull one over on top of yourself, again there is much more potential risk to people in the dementia unit. On the second day of the inspection the maintenance man had purchased brackets to secure the wardrobes to the walls. We were told that the furniture had been audited and some had been condemned other items will be replaced where necessary.There will also be an ongoing refurbishment of soft furnishings, including carpets, curtains and bedding. Some bedding had already been purchased. Lounge areas allow for people to be seated together enjoying the entertainment systems on offer and any group activities or events. The televisions are quite small for the size of the rooms and it would be difficult for people with visual impairment to see adequately. The manager told us that she had identified this and action will be taken. As part of the refurbishment programme they are looking at various ways that space within the home can be modified to accommodate things such as a sensory room. Some of the environment issues show complete lack of respect for the people living in the home and should have been addressed before our visit, however we are satisfied and have been assured that an improvement plan will be actioned following a detailed audit of the home. We will look at all the progress with regards to the shortfalls identified during future visits to the home. Care Homes for Older People Page 22 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home must continue to promote staffing levels and skill mix of staff in order to help ensure that people needs can be met. The recruitment policies and procedures set up in the home should help ensure that people living in the home are supported and protected. The training provided to staff should help ensure that staff have the skills and resources to meet peoples needs. Evidence: The manager told us that staffing levels should be indicative of needs and the level of care required and confirmed that levels of staff would rise should dependency levels increase. We were told that the home also increases the levels of staff at certain busy times of the day to ensure that needs are met. We ask people living in the home if staff are available when needed, four replied, Always, two replied Usually and three said Sometimes. Staff are asked in their surveys, are there enough staff on duty to meet the needs of people, one replied Sometimes and one said Never. We spoke with staff and people living in the home and the response to staffing levels varied. Care Homes for Older People Page 23 of 29 Evidence: Comments included, I feel there are some staff shortages at times but the quality of care is good, Sometimes I feel like we take shortcuts because of limited time and we might not be able to bath people, Please recruit more staff as the pressure put on staff is enormous and I think we give good care and we manage staff shortages well. In discussions with the manager it was agreed that staffing levels, dependency levels for individuals and daily routines need to be audited to ensure that people are receiving care in a timely manner that suits their personal preferences and that staff feel supported to be able to give appropriate care safely. The home follows a good recruitment procedure. This will help ensure that the right people are employed to work at the home, and people living in the home will be further protected. Records contained completed application forms with a full employment history, two written references and Criminal Records Bureau (CRB) disclosures. Qualified staff nurses, are required by law to register annually with the Nursing and Midwifery Council NMC to be able to practice, these registrations are checked annually by the manager to ensure that the staff have done this. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, Health and Safety and the Protection of Vulnerable Adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. The manager has been working hard to access and provide the staff at the home with training and development opportunities tailored to individual needs. The manager and all staff are conscientious in attending training relevant to the care needs of the people they are caring for and those relevant to the roles they perform and the response to the staff surveys supported this. We look forward to seeing the progress made regards effective training during our future visits. We spent some time throughout the day talking and observing staff carrying out their duties and assisting people. At times staff were warm, good humoured and sensitive towards people within a relaxed calm environment. Comments received about the staff were very positive including, Staff are friendly and courteous, The training of staff has improved over the last two years in my opinion, There is a new established workforce with good continuity of care and The staff are aways polite and kind. Care Homes for Older People Page 24 of 29 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. We are satisfied that the outcomes for people who use this service will improve and that peoples needs and best interests are central to the new management approach in the home. Good accounting methods are adopted and policies and procedures are followed correctly when handling personal money so they can be sure their finances will be managed correctly. The health and safety checks within the home will help protect the people who use this service. Evidence: There have been three managers at the home in the last year and continuity of management has been compromised. The current manager has twenty nine years experience in care and completed her Registered Managers award in 2009. She has been employed by Mimosa for some time as both a deputy manager and a registered Care Homes for Older People Page 25 of 29 Evidence: manager in other homes owned by Mimosa. Having managed a sister home for three years and having received a 2 star rating she has agreed to apply for the registered managers position at Kingsmead in order that the home has some stability for all the people who use the service and so that work can continue to improve the quality of services provided. We are mindful that the manager had only been at the home for twenty one days in full capacity at the time of our visit. Some outcomes for people who use the service have improved since the last inspection. In the short time that the manager has been appointed she has started to make an improvement plan based on audits she has conducted in the home. Several meetings have been held with people who live the home, relatives and staff to keep them informed and share information about plans for the future. We spoke with staff about the continued change in management and people appeared confident with the new manager in post. Comments included, The manager has had a positive effect in the home, We need someone strong who will make the required changes and I just like the fact that she is taking charge and making positive changes. Despite a repeated adequate rating for this inspection, we believe that the newly appointed manager and staff are working towards being a stable team that are committed to providing quality of care for the benefit of the people in their care. The home continues to monitor and assess the quality of services provided by giving people questionnaires to complete, any weaknesses identified are put into an action plan. Regular audits are carried out in the home including health and safety care documentation, medication and other procedures in the home. The home has policies and procedures in place for holding peoples personal money, statements of individual accounts are kept and good accounting methods are maintained, receipts for sundries are also kept for proof of purchase. Some of the Health and Safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 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. 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