Care Home: Kingston Court Care Home

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What the care home does well The home is good at ensuring that they undertake good assessments of new people to make sure they can give them the right levels of care and nursing. People receive suitable nursing care and benefit from visits from other health care professionals. People with dementia see specialists from psychiatric services. Residents are protected by safe systems for managing medication. Record keeping was good so that the treatment required was clearly set out. We learned from people who live in the home - and from our observations using SOFI that people are generally satisfied with the way nurses and carers deliver care to them. "Care is good and the staff are excellent..." "The nurses are good at looking after my needs." People were happy with the approach of staff. We saw some very nice interactions between staff and residents.Care of people with dementia was observed to be done with patience and empathy. "Overall standard of care is acceptable..." "The staff take care of me...". The home is building a reputation for delivering good care to people at the end of life. Visitors told us in surveys and on the day that they are made welcome in the home. Local community groups are encouraged to visit the home. Most people were happy with the food provided in the home. "The food is nice and staff make sure I am Ok with what is offered..." The company manage complaints well and no residents or visitors had any complaints when we visited. People were happy with their spacious bedrooms and ensuite facilities. The home was clean and tidy on the days we visited. People were happy with the way their clothing and bedding were cared for. "Provides a fresh, clean home..." We judged that most of the time there were suitable numbers of staff on duty on each shift. The units are normally led by a trained nurse who supervises a team of carers. Care staff are supported and encouraged to undertake National Vocational Qualifications in care. The manager is careful to only start new staff once she has checked the person`s background and taken up references. Most care staff have had the opportunity to complete core training. The home is managed by a suitably experienced and qualified person who has good levels of support from the company. The company has a quality management system that they were using to check on some of the issues we looked at during the day. They use surveys and have meetings and also check on the management systems. We checked on the way the home helps people to manage small sums of cash. This was being handled correctly. Routine maintenance of the building and checks on equipment were being done correctly. What has improved since the last inspection? The written plans of care have improved since our random visit with more details of the kind of support people need. The staff team continue to improve the way they work with health care professionals. They have made sure that people who are classed as `residential` have care from the district nursing service. We saw ongoing improvements for activities and entertainments for residents. The manager has become more confident in reporting any allegations of abuse or neglect. Arrangement and training on preventing cross infection and dealing with continence products had improved. What the care home could do better: We want the manager and the company to look again at the routines of the day. We judged that some routines need to be more flexible so that people will receive more individual care. Here are some things people said in surveys. "They could serve breakfast earlier. Could improve activities and outings...I am not tol what is available..." "More occupational activities ....the opportunity to go for some fresh air. A walk with a carer perhaps...The quality and variety of food could be improved and the arrangements ar mealtimes...." "More activities inside and out..." Overall the service manages medication well. However, there were occasions where care plans relating to medication were incomplete and needed updating. The service needs to make sure they continue to do regular checks of medication as part of their quality auditting system. People told us they want more activities and we judged that there needed to be more specialised activities for people with dementia. We recommended that the company look into these things when they are developing their future plans. We also judged that some people who have nutritional needs would benefit from more specific menu planning to give them tempting and nourishing foods. We discovered that some staff were not very confident about how to manage any matters of adult safeguarding and some were not sure that they would be properly supported if they were to disclose anything of this nature. We want the company to make sure that all staff are trained and competent in identifying and managing any allegations of abuse. Although this home is purpose built there are some design issues that can be problematic. These include access to the garden, the lack of facilities for making drinks and snacks on the floors and the space provided for communal areas. We recommend that the manager keeps working on how to manage these things so people can get the best use of their environment. We want the manager to look at staffing ratios on the dementia care unit in the afternoon so that people with dementia can have staff support in activities. Staff in this home do not get paid to attend training. We want the company to consider the implications of this for the development of their teams. The manager and the company had identified some people who needed to work on their practice and competence. We discovered that some of these individuals had not attended training and had not received suitable supervision and development. Formal supervision is not happening as regularly as it should and the notes of any meetings are not detailed enough. The manager and the company need to look at staff supervision, development and training to make sure people get the best standards of care. We checked on the arrangements for giving staff fire instruction and drills. Although some had taken place and some people had received fire training we discovered that not all staff had received suitable instruction. Some people who could be in charge in a fire situation had not attended instruction or training Key inspection report Care homes for older people Name: Address: Kingston Court Care Home Newtown Road Carlisle Cumbria CA2 7JH     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: Nancy Saich     Date: 2 2 1 0 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 32 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 32 Information about the care home Name of care home: Address: Kingston Court Care Home Newtown Road Carlisle Cumbria CA2 7JH 01228528542 01228528638 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Express Care (Guest Services) Ltd care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only. Care home with Nursing - Code N To service users of the following gender: Either 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: 53) Dementia - Code DE (maximum number of places: 27) The maximum number of service users who can be accommodated is: 80 Date of last inspection Brief description of the care home Kingston Court is a modern purpose built home that provides nursing care for older people twenty seven of whom may be people with dementia. The home is arranged over three floors with the top floor accommodating people with dementia. Express Care owns the home. This company is a wholly owned subsiduary of Executive Care Homes for Older People Page 4 of 32 Over 65 0 53 27 0 Brief description of the care home Care.They have other homes in England - including one other home in Cumbria. Mrs Jean Walker manages the home on their behalf. The home has been registered since spring of 2007. The home is situated in central Carlisle near to the Cumberland Infirmary. It is within easy travelling distance of the centre of the city. It is also within walking distance of local shops and amenities. There is a car park to the front of the home and garden areas for residents. Accommodation is in single occupancy rooms. Information about the service is available in the Statement of Purpose that includes a copy of the last report. There is also a colour brochure. The cost of care ranges from £398 to £550 per week depending on need. Further information about the costs can be obtained from the manager or the company. Care Homes for Older People Page 5 of 32 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 inspection was carried out over two days with four inspectors. On the first day the pharmacy inspector, Angela Branch, carried out an inspection of medicines in the home. On the second day three inspectors visited the home and each of them concentrated on a separate unit within the home. The lead inspector, Nancy Saich and Elaine Brayton, Local Area manager each concentrated on the ground and first floor nursing units. Margaret Drury spent time on the specialist dementia care unit and completed what is called a Short Observational Framework for Inspection (SOFI). To do this the inspector sits quietly with residents and observes the way they interact with each other, how staff treat them and how they occupy themselves. We had also undertaken a random inspection on 01/09/2009 because there had been a concern raised about care and nursing standards. This report can be downloaded from Care Homes for Older People Page 6 of 32 our website or a paper copy ordered from our helpline. Before these two visits we asked the manager to complete the Annual Quality Assurance Audit (the AQAA). This is a document that asks the manager to tell us about developments in the home in the preceding year and for their plans for the future. We also ask for some statistics about people who live in the service and about staffing levels. This was done promptly and with suitable details. We then sent postal surveys to residents, their relatives and to staff. We had a good return from these surveys and we quote from these in this summary. We also contacted social workers, health care professionals and other people who visit the service. We looked at the information we had received since the last inspection. This included any complaints, accident reports and notifications of any allegations of abuse. We had received some concerns about the service from various sources and we looked at these during our visits. Care Homes for Older People Page 7 of 32 What the care home does well: The home is good at ensuring that they undertake good assessments of new people to make sure they can give them the right levels of care and nursing. People receive suitable nursing care and benefit from visits from other health care professionals. People with dementia see specialists from psychiatric services. Residents are protected by safe systems for managing medication. Record keeping was good so that the treatment required was clearly set out. We learned from people who live in the home - and from our observations using SOFI that people are generally satisfied with the way nurses and carers deliver care to them. Care is good and the staff are excellent... The nurses are good at looking after my needs. People were happy with the approach of staff. We saw some very nice interactions between staff and residents.Care of people with dementia was observed to be done with patience and empathy. Overall standard of care is acceptable... The staff take care of me.... The home is building a reputation for delivering good care to people at the end of life. Visitors told us in surveys and on the day that they are made welcome in the home. Local community groups are encouraged to visit the home. Most people were happy with the food provided in the home. The food is nice and staff make sure I am Ok with what is offered... The company manage complaints well and no residents or visitors had any complaints when we visited. People were happy with their spacious bedrooms and ensuite facilities. The home was clean and tidy on the days we visited. People were happy with the way their clothing and bedding were cared for. Provides a fresh, clean home... We judged that most of the time there were suitable numbers of staff on duty on each shift. The units are normally led by a trained nurse who supervises a team of carers. Care staff are supported and encouraged to undertake National Vocational Qualifications in care. The manager is careful to only start new staff once she has checked the persons background and taken up references. Care Homes for Older People Page 8 of 32 Most care staff have had the opportunity to complete core training. The home is managed by a suitably experienced and qualified person who has good levels of support from the company. The company has a quality management system that they were using to check on some of the issues we looked at during the day. They use surveys and have meetings and also check on the management systems. We checked on the way the home helps people to manage small sums of cash. This was being handled correctly. Routine maintenance of the building and checks on equipment were being done correctly. What has improved since the last inspection? What they could do better: We want the manager and the company to look again at the routines of the day. We judged that some routines need to be more flexible so that people will receive more individual care. Here are some things people said in surveys. They could serve breakfast earlier. Could improve activities and outings...I am not tol what is available... More occupational activities ....the opportunity to go for some fresh air. A walk with a carer perhaps...The quality and variety of food could be improved and the arrangements ar mealtimes.... More activities inside and out... Overall the service manages medication well. However, there were occasions where care plans relating to medication were incomplete and needed updating. The service needs to make sure they continue to do regular checks of medication as part of their Care Homes for Older People Page 9 of 32 quality auditting system. People told us they want more activities and we judged that there needed to be more specialised activities for people with dementia. We recommended that the company look into these things when they are developing their future plans. We also judged that some people who have nutritional needs would benefit from more specific menu planning to give them tempting and nourishing foods. We discovered that some staff were not very confident about how to manage any matters of adult safeguarding and some were not sure that they would be properly supported if they were to disclose anything of this nature. We want the company to make sure that all staff are trained and competent in identifying and managing any allegations of abuse. Although this home is purpose built there are some design issues that can be problematic. These include access to the garden, the lack of facilities for making drinks and snacks on the floors and the space provided for communal areas. We recommend that the manager keeps working on how to manage these things so people can get the best use of their environment. We want the manager to look at staffing ratios on the dementia care unit in the afternoon so that people with dementia can have staff support in activities. Staff in this home do not get paid to attend training. We want the company to consider the implications of this for the development of their teams. The manager and the company had identified some people who needed to work on their practice and competence. We discovered that some of these individuals had not attended training and had not received suitable supervision and development. Formal supervision is not happening as regularly as it should and the notes of any meetings are not detailed enough. The manager and the company need to look at staff supervision, development and training to make sure people get the best standards of care. We checked on the arrangements for giving staff fire instruction and drills. Although some had taken place and some people had received fire training we discovered that not all staff had received suitable instruction. Some people who could be in charge in a fire situation had not attended instruction or training 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 10 of 32 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 11 of 32 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. The home is good at making sure they can give people the care and services they want and need and that the person will fit in with the existing groups. Evidence: We asked for and recieved a copy of the information given to both prospective residents and to the people who buy care on their behalf. These documents were of a good standard. The company agreed to keep these under review and are going to look at adding a little more information about how they help people at the end of life. We looked at the files of a number of new residents and we saw that they had been visited and their needs assessed prior to coming to look around. Good pre and postadmission assessments were on file. An interim care plan is started shortly after admission to help staff care for new people properly. Everyone has a review after six weeks when they can decide on their future. We met some people who told us they were still thinking over the placement. We Care Homes for Older People Page 12 of 32 Evidence: judged this to be very good as people need time to consider all their options. Care Homes for Older People Page 13 of 32 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 in this home receive good levels of care at all stages of life and we could see that efforts were being made to continually improve this. Evidence: We read a number of the written plans that help people get good levels of care and services. We read three on each unit in depth and met the people who the care plan was written for. The pharmacist inspector read a range of individual plans.We also looked at others more briefly. We saw good, detailed and up to date plans. They included very good instructions for staff to follow in relation to nursing and personal care needs. We also saw good strategies for helping people who might have challenging behaviour. We had evidence to show that many of the plans gave ways to support people when medicines or nursing needs changed. Plans to support good skin care and nutrition were in place and we want the manager to continue to work on these after staff have received more training. Some of the plans relating to encouraging people to eat would benefit from more detail. We judged that a lot of work had been achieved since we went out to do the random visit when we asked that some plans be improved. Care Homes for Older People Page 14 of 32 Evidence: We observed people receiving good levels of care that were written into these care plans, Social Services had reviewed the care of some people and the outcomes were good for these too. We did think that some plans would benefit from being more centred around individual needs and choices and we discuss this further in the next section. The care plans show that G.Ps and district nurses visit where appropriate. There had been some problems in the past where district nursing help for non-nursing people had not been sought but this now no longer happens and we saw evidence of these nurses visiting, treating people and giving advice and equipment. People saw psychiatrists, specialist nurses, occupational therapists and speech therapists. The tissue viability nurse comes to the home as does the person who specialises in end of life care. People told us the nursing was very good and that they saw health carers from out of the service whenever they needed them. There were records showing that nurses employed by the home take blood samples and check on things like blood pressure and assess any health needs people may have. The pharmacist inspector checked medicines management in the home and found that in general this was done well. Records for receipt, administration and disposal of medication were well kept. There were one or two occasions when a medicine had been refused and this was not recorded. We checked on availability of medicines in the month before the inspection and found only one minor problem that was resolved on the same day. We counted some medicines chosen at random to see if they tallied with records. This showed that medicines could be accounted for and that people received their treatment in the correct dose. There were two small discrepancies with antibiotics and we want the manager to make sure she continues to monitor this. We checked on care plans relating to medication and paid particular attention to those where people had when required or specialist medicines. These were mostly good and gave good guidance on managing care so that treatment was appropriate,safe and effective. Occasionally people did not have plans for when required sedatives and one potent drug with complex side effects did not have full information on a care plan. We checked controlled medicines and these were in order on the day. There had been a minor discrepancy and the company were still investigating this. We want the provider to inform us of the outcome of this. We saw evidence that staff had recently been assessed as competent in the safe handling of medicines. All of the inspectors observed very nice interactions between staff and residents and we judged that generally people were treated with courtesy and dignity. Most of our Care Homes for Older People Page 15 of 32 Evidence: surveys and discussions on the day confirmed that residents thought the staff were very good. Staff were open with us and keen to make things better for people. The care of people with dementia was done with patience, skill and calmness and the inspector who completed observations on the Memory Care unit was impressed with the way staff treated people. There were some comments on staff surveys and in other information we received on the day that meant we alerted the company of some allegations made about some staff. We had no formal evidence of this but we discuss this later in the report. This home has built a reputation for care for very frail people who are at the end of their lives. We saw evidence to show that nurses and carers follow good practice guidelines on end of life care. We judged that the company might want to formalise this service they provide. We saw one or two plans where people had asked not to be resuscitated and we were pleased to hear that the nurses on the unit were going to look at strengthening these directives with the help of the Cumbrian end of life co-ordinator. We ask that the company tell us when they have looked at the policies and procedures on this. Care Homes for Older People Page 16 of 32 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. The service needs to look at how individual needs are met in terms of the routines of daily living so that a more person centred approach is taken to the way people live. Evidence: We arrived just after eight in the morning and people were beginning to get up. Staff were busy helping people get ready for the day. Some people preferred to get up later but most people got up for breakfast. Breakfast is served in the home when almost everyone is up. On the day of our visit this was around 9 a.m on some units and after 9.30 a.m on one. Our surveys and some people on the day said they didnt like to wait for breakfast. The manager has dealt with this by making sure that night staff give early risers tea and a snack. However we recommend that the manager look at how these arrangements are working. We suggested that a staggered breakfast regime might work. We also noted that although there are now toasters on each floor and a fridge on the units almost all of the drinks and food preparation is done in the main kitchen. The units have no fresh water other than jugs of water brought from the kitchen. We judged that people might get a more individualised service if staff had access to fresh water and a kettle for drinks and there were more snack foods and cold drinks available in the dining areas. Care Homes for Older People Page 17 of 32 Evidence: We learned from residents that there had been a number of outings in the late summer when the home had the use of a company mini-bus. We also heard about entertainers who had come to the home, the regular visits from the church, weekly hairdressing and some reminiscence work that had taken place. The home has an activities co-ordinator and we saw evidence of her doing craft work with people and spending time with individuals. She is limited by the hours she works and the numbers involved but we were told that residents enjoy her activities. A number of people on the day and in surveys told us they wanted more activities and more entertainments and trips out. Several people said they wished it was easier to sit out in the garden and they felt they wanted more support to do this. We also judged that although there was evidence of some specialised activities on the dementia care unit there could be more. A senior manager from the company said they were continuing to look at this work and we make a recommendation that arrangements for specialised activities are reviewed. People told us they were happy with the way the home welcomes their visitors and we met a number of relatives and friends on the day. They were satisfied with the way they were received in the home. We also had some surveys from visitors and these too said that visiting arrangements were satisfactory and staff kept them up to date with the care of their relatives. People told us that they had choices in the way they spent their time. One or two people told us that they were encouraged to do as much as possible for themselves.We saw that choice was included in some care plans and there were minutes from residents meetings. We judged that people were asked about their preferences but we judged that once improvements are made to the flexibility of daily life, people will have more choice Most people were happy with the food offered in the home although one or two surveys commented on having to wait for meals and on the quality and choice. We saw two meals served on the day and we judged them to meet the standards. We saw that people have their nutritional needs met but that when people needed to eat more the staff relied on giving dietary supplements. We want the nursing team to look at this with the manager and the cook to find ways to ensure individuals have the kind of tempting foods with high protein and high calorie values needed to prevent malnourishment. Care Homes for Older People Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We judged that the time is right to make sure both staff and residents understand how to report any concerns, complaints and allegations so that people can have the best possible care and treatment. Evidence: There had been some complaints brought to our attention and we sent these to the company to investigate. This had been done thoroughly and promptly. On the day people told us they would go to the manager or her deputy. One or two surveys said they were a little unsure of how to complain but generally people were happy with the arrangements. We had also been kept informed of any issues that the manager judged to be actually or potentially harmful to residents. We saw that the manager had become more confident in managing these. We did receive information around the time of our visit that led us to believe there was a possibly serious issue of poor practice in the home. Two senior managers from the company were dealing with this matter along with Social Services. We also judged from surveys and other information that some staff did not feel comfortable with the arrangements in place for disclosing any information about safeguarding. Not all staff were confident about how to manage any allegations of abuse. Again Care Homes for Older People Page 19 of 32 Evidence: senior people from the company started to look at this on the day. We want the company and the manager to make sure that staff know how to manage disclosure or making allegations and that both residents and staff feel confident about doing this. Care Homes for Older People Page 20 of 32 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. People who live in Kingston court have a clean, safe and comfortable home where they can feel relaxed. Evidence: This home is a purpose built building on three floors. It is situated next to the Cumberland Infirmary, is on a regular bus route and near to local shops and facilities. Parking is at the front of the property.The centre of Carlisle is a short drive away. There are good design features of this building that help people who may have restricted mobility. It is user friendly for wheelchairs and the company do provide some specialist equipment for individuals. They also access specialist beds, mattresses and manual handling equipment from the health service. The building does however have some design elements that the company need to keep under review. We have mentioned these in other parts of this report. These include access to the garden space and the lack of integral kitchens in the dining areas. Overall there is enough space for individuals so that the environment meets the standards. However the dining rooms and the lounges do sometimes feel cramped. A number of residents do use their rooms for large parts of the day and they told us they liked their large, ensuite bedrooms.The call bell system worked well and people could access it easily. The manager has tried to overcome these matters but we do Care Homes for Older People Page 21 of 32 Evidence: consider that further thought needs to be given to some of these issues. People were very happy with their individual rooms and we checked on a number of rooms. People felt free to spend time in them and there was plenty of space for easy chairs and other pieces of furniture. Ensuite facilities were suitable for people with mobility needs. At the random inspection we asked that unused rooms and rooms belonging to people on leave or in hospital are locked. This had happened when we returned to complete this inspection. We would like to see a few more people feeling confident about retaining their own keys and locking the doors of their rooms. This needs to be integrated into the work the company need to do on routines of the day that we covered earlier in this report. We look forward to seeing any future plans about managing the environment within the company routine business planning. On the day of the visit all areas were clean and tidy. We were told in surveys that sometimes there are days when there are a lot of unpleasant odours and that some areas get very hot. If this had been a problem staff told us it was short lived and we saw the housekeeping staff working effectively to prevent this and the care staff took a lot of care over helping people with personal care needs. Staff have had training in infection control and there was suitable equipment readily available on the day. We did question the quality of disposable gloves and this was dealt with during the visit. We had evidence to show that continence products are ordered and disposed of appropriately. Some improvement has been made to the systems for disposal and a reasonable yellow bag system operates quite well. This has been improved since last year and the previous requirement has been met. People told us they were happy with the way the staff kept their clothing and their bed linens. People were dressed in fresh, well pressed clothing and the beds all had fresh linens. Care Homes for Older People Page 22 of 32 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. Staff training and development needs to be managed in a more planned and proactive way so that people will receive the best quality and most up to date nursing and care that can be provided. Evidence: We asked for copies of the last four weeks rosters and we received data on staffing within the AQAA. We also spoke to people who live in the home and to staff. We had learned that sometimes staff who work at night consider themselves to be understaffed. We could find no evidence of this in rosters or from people who live in the home. We asked staff on the day and they said they were kept going at night but normally there was time for their break and time to spend with residents. One resident who had a bad night told us on the day that night staff had enough time to sit a while with her and bring her a cup of tea and a snack. Generally the home has suitable staffing ratios in place at all times and there is normally a nurse working on each floor alongside carers. They are supported by housekeeping and managment staff. We did think that mid afternoon cover on the dementia care unit needed to be looked at again so that there were enough staff around to spend quality time with residents. We make a good practice recommendation that ratios on this unit are reviewed. Care Homes for Older People Page 23 of 32 Evidence: A number of staff have completed their National Vocational Qualification in care and newer members of staff have been registered for this NVQ award. We judged that although numbers are low on attainment this meets the standard as the home has only been open for a short time and a number of staff are on the verge of finishing the award. Staff are suitably recruited to this service. We looked at a number of new recruitments and checked on some existing staff. The manager gets suitable references, interviews people thoroughly and makes sure they do not have a criminal record and have not been dismissed from any other care setting. Nurses have their qualifications and right to practice checked. All of these recruitment issues were managed appropriately. The company do deal with other personnel matters and we looked at some of these. We refer to this again in management but we judged that there is a need to look more closely at how personal development and training is being managed for all levels of staff. We were shown a matrix of training completed and we looked at individual training files. We saw that some staff - especially care staff - had received good levels of training in the last year. A number of files seen and people spoken to confirmed that carers completed induction and that they had manual handling, 1st Aid and health and safety awareness. We also saw that some staff had received training on dementia awareness, nutrition, challenging behaviour and other relevant short courses. We did discover that people do not get paid for training and the national minimum standard is for three days paid training per year. Some people said they had problems going to training on their days off because of this. We looked at individual files and some people had not had enough in-depth supervision to identify training and development needs. Some records of training showed no training since 2007. We were unsure as to whether this was a problem with record keeping or whether people did not attend or whether training needs more management planning. We were concerned when we learned that some people had development needs and when we looked at their files it showed no training and little supervision. Nurses on duty did say they tried to attend training to keep their clinical portfolios up to date and that they were checked by more senior nurses on their practical application of nursing procedures. However it was difficult to find a comprehensive plan for individual development and for records of training attended or skills learned by some nurses. Care Homes for Older People Page 24 of 32 Evidence: We had evidence that showed that there might be some poor practice in the service and we had been told about some disciplinary action that the company had taken. When we looked at this in more depth we saw that the individuals involved had not had the kind of competence checks, training or personal development work needed to help them improve their practice. We now require the company to look at development and disciplinary matters to help lessen any risks to residents. We want the company to develop a full personal development programme for their staff teams at all levels so that people who live in the service are given the best and most up to date nursing and care they need. Care Homes for Older People Page 25 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The irregularity of fire drills and inconsistent supervision of staff means that management systems need to be reviewed and updated so that staff will be able to deliver good, safe standards of care and services at all times. Evidence: This home is managed by Mrs Jean Walker who is a trained nurse and has a number of years of experience in nursing homes and hospitals. She is suitably qualified and we had evidence to show that she has good support from the company. We saw evidence to show that the company and the manager do follow routines and do regular checks on quality. We were told by a senior person in the company that a quality audit had been done. We did not see a copy on the day but we asked that any updates be sent to us. We received an interim improvement plan for the issues we raised on the day by the end of our visit. We also learned of a number of new initiatives (for example plans to develop the approaches on the Dementia care unit) that the company are taking after looking at quality issues. Care Homes for Older People Page 26 of 32 Evidence: We checked on money kept on behalf of residents and the accounts reconciled with the amounts of money held. We checked on supervision records for all grades of staff. We found that the records were not as detailed as they might be for some people. Some staff said they had regular supervision but other people admitted that they had received very little. We checked on a number of individual files and we found that formal supervision did not meet the standard for a number of staff at different levels and stages. We were concerned that this reflected on a lack of personal and team development. Some evidence was seen on the day and in concerns and complaints raised that pointed to poor practice and the company had dealt with some issues on a disciplinary basis but there was little evidence to show that staff competence or delivery of care was being developed in a planned way. Some people had received supervision and we could see that their good practice and training needs were worked on and they were well supported. However others needed more help, support and advice. We did hear from management that practice was looked at but the notes of any management intervention need to be more detailed and where there are questions raised about competence the company need to support the homes management. We looked at the records of maintenance and routine work on the environment and checks on equipment. This were done appropriately. We spoke to the maintenance person and he described the routines he and his collegue carried out. These were done correctly. They completed the checks on fire safety and these were up to date. We looked at the fire log book and found that there had been fire training undertaken and drills and instructions given over the year. However when we cross referenced these with staff files we found that not all staff had received these regularly. Some people who could be left in charge at night had insufficient training, drills and instructions. We want the manager and the company to put this right. One person told us they hadnt gone to fire training as they do not get paid for attendance. Care Homes for Older People Page 27 of 32 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 28 of 32 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 13 It is required that the company review all arrangements in the home for recognising, reporting and managing matters of adult protection. They must also ensure that the arrangements for whistle blowing by staff are reviewed and all staff reminded that they will be supported and protected if they disclose any poor practice. This must be done to ensure that any poor practice is dealt with promptly and appropriately. 18/12/2009 2 30 18 It is required that a full review of training, competence and development is undertaken for all staff. This must be done to ensure that staff are properly 18/12/2009 Care Homes for Older People Page 29 of 32 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 trained in the job role they undertake and that their practice is monitored so that people receive the best levels of care. 3 36 18 It is required at all staff have regular and in-depth supervision with a more senior person. This needs to be recorded and adress any training or personal development needs. This needs to be done so that staff are up to date with current good practice, have clinical updates and have the opportunity to discuss their performance. This needs to be done so that people will be guaranteed good standards of care at all times. 4 38 23 It is required that all staff receive fire drill and instruction at regular intervals of three or six months dependant on their job role and responsibility. This must be done so that staff are confident in a fire situation and can keep people safe. 18/12/2009 18/12/2009 Care Homes for Older People Page 30 of 32 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 9 12 It is recommended that the manager continues to review and update all the care plans in the home. It is recommended that auditing of medication held on behalf of residents is continued. It is recommended that the registered person review the arrangements for leisure and therapeutic activities so that the varied and complex needs of all individuals are met. It is recommended that the registered person consider how the routines of the day are managed so that people receive flexible and individualised care. It is recommended that the registered person review nutritional planning in the home and look at the provision of special diets, especially where there is the risk of people becoming undernourished. It is recommended that some of the issues relating to the use of space and facilities are kept under review and that investment is considered to improve the way people use the environment. It is recommended that staffing levels during the afternoon are reviewed on the specialist dementia care unit so that people will receive good levels of care at all times. It is recommended that all staff receive three days paid training per year. 4 12 5 15 6 19 7 27 8 30 Care Homes for Older People Page 31 of 32 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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