Care Home: Kippington`s Nursing Home

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What the care home does well People are given information about Kippingtons and benefit from an opportunity to look around before they make a decision to move in. People benefit from an assessment before they move in, which aims to ensure that the home is suitable to meet their needs. Residents live in a comfortable, clean and attractive environment. Residents benefit from suitable facilities and equipment, which can help to maintain their independence. The home is run by an experienced and qualified manager. Residents benefit from a full staff team who are allocated in sufficient numbers. Residents are protected by the systems in place for staff recruitment. Staff are provided with training designed to meet the needs of residents and supported by regular supervision. The views of residents and their representatives are sought regarding the care they receive and how the home is run. Residents changing personal, health and social care needs are monitored and reflected in care plans. There are systems in place for the administration of medication, which aim to protect residents. Residents can choose to take part in group activities or pursue their individual interests; they are able to keep in contact with their relatives and friends if they wish. Residents can choose what they eat and are provided with a choice of meals There are systems in place which aim to protect residents financial interests. Records indicate the testing and maintenance of systems and equipment within the home. What has improved since the last inspection? The Manager of the home was appointed in October 2009, since when they have worked hard towards addressing issues raised and improving standards of care within the home. All requirements made at the last Key Inspection in November 2009 have been addressed. Improvements made since the last Key Inspection include: The Manager was registered with the Commission in March 2010. All care plans have been updated and a new format has been introduced which is clear and easy to follow. Care plans are coded regarding residents resuscitation status. Daily notes are written by both nurses and carers. Care plans for mental capacity and decision making are now in place. Staff are provided with training in the Mental Capacity Act, Deprivation of Liberty and the Protection of Vulnerable Adults. Care plans are evaluated regularly and audited by the Manager. One residents care plan, needs and choices is reviewed on a daily basis with nurses, carers and the Chef. Relatives are invited to take part in care plan reviews and assessments are shared with both residents and their relatives. The system for the storage and administration of medication has been reviewed. There is now one medication room for each wing of the house, which provides more space for staff to operate than previously. Local written medication procedures for the home have been developed. A system of different coloured trays was introduced at the time of the last Key inspection, which aims to identify clearly residents who need assistance with eating. A system of questionnaires has been developed for residents regarding their choice and preference in a variety of areas. Regular resident and relatives meetings take place including sub groups for food and activities. Kippingtons now produces a newsletter. Since the last inspection staff have been recruited to all previous vacancies. Staff have been appointed for the Deputy Manager post and twenty four hours nursing and will start work shortly, after which the home will be fully staffed. There are an increased number of bank relief carers. There are now three Activities Coordinators. A second chef and permanent maintenance man have been employed. A new system has been introduced to ensure that all the relevant recruitment checks and documentation is in place. The Manager has developed a new system for staff allocations and named nurses. Walkie Talkies are now used for communication between nurses and senior staff. What the care home could do better: The health and safety of residents may be improved by addressing recommendations made by the Environmental Health Officer regarding the kitchen floor. Key inspection report Care homes for older people Name: Address: Kippington`s Nursing Home Grange Road Oak Lane Sevenoaks Kent TN13 2PG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Martin     Date: 1 2 0 5 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 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) © 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 32 Information about the care home Name of care home: Address: Kippington`s Nursing Home Grange Road Oak Lane Sevenoaks Kent TN13 2PG 01732451829 01732742984 jackie.grant2@ntlworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Oakdene Care Limited Name of registered manager (if applicable) Ms Janet Ellen Collings Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommmodated is: 55 The registered person may provide the following category/ies of service only: Care home with Nursing (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 (OP) Physical Disability (PD) Date of last inspection Brief description of the care home Kippingtons Nursing Home provides nursing, personal care and accommodation for up to fifty five older people, five of who may also have a physical disability. Oakdene Care Limited owns the home, which is located on the outskirts of Sevenoaks; it is easily accessed by car, with the M25 and A21 nearby, and mainline rail links a short distance away. Care Homes for Older People Page 4 of 32 Over 65 55 0 0 55 Brief description of the care home The home is situated in 1.5 acres of private grounds; these are well maintained and can be accessed by disabled residents. There are car parking facilities to the front of the property. Residents accommodation currently consists of forty five single bedrooms, twenty three of which have en suite facilities, and five double bedrooms. The home can be accessed at all levels by the use of a passenger lift of a size suitable for wheelchair users. Available activities include quizzes, bingo, arts and crafts and music for health sessions. Holy Communion services take place monthly. Fees vary depending on the type of room, dependency and funding eligibility. The current fees range from 749.00 to 1,100 per week. Residents pay separately for hairdressing, newspapers and magazines, personal toiletries, chiropody, manicuring and private telephones. Full details of the service provided and the fees charged are available from the Manager. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Kippingtons Nursing Home provides nursing care and accommodation for up to fifty five older people. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This Key Inspection was undertaken by two Compliance Inspectors on 12th May 2010. This included a visit to the home in Sevenoaks where the Responsible Individual, Registered Manager, one Nurse, two Carers, one Activities Coordinator, the Chef, the Administrator, the maintenance man, domestic staff and Service Users were spoken with. Some judgements about the quality of the service provided were taken from observation and conversation. Some records and documents were looked at together with the premises and facilities of the home. In addition nine postal surveys were received. Care Homes for Older People Page 6 of 32 We undertook a Random Inspection on 18th March 2010, which looked at compliance for requirements made at the previous Key Inspection of 16th November 2009, all of which were addressed. Some issues from the Random Inspection have been included in this report, both of which should be read in conjunction. Currently a Safeguarding Vulnerable Adults investigation continues to be undertaken confidentially by a multidisciplinary team coordinated by Social Services. There have been some outcomes achieved whereas others have not yet been reached. During this investigation, Kent Social Services have suspended their contract with the home. As the Safeguarding investigation is not yet complete, these issues have not been included within this inspection process. This inspection does include looking at any regulatory issues relating to all core standards, including Safeguarding procedures. All information received since the last Key Inspection is reviewed as part of our inspection methodology. Some of the gathered evidence is mentioned within this report where appropriate. When all outcomes have been reached, the Safeguarding team will make recommendations and develop an action plan for the home. The home needs to demonstrate that improvements in the standard of care can be sustained together with the implementation of any recommendations made by Social Services as a result of the Safeguarding investigation. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The Manager of the home was appointed in October 2009, since when they have worked hard towards addressing issues raised and improving standards of care within the home. All requirements made at the last Key Inspection in November 2009 have been addressed. Improvements made since the last Key Inspection include: The Manager was registered with the Commission in March 2010. All care plans have been updated and a new format has been introduced which is clear and easy to follow. Care plans are coded regarding residents resuscitation status. Daily notes are written by both nurses and carers. Care plans for mental capacity and decision making are now in place. Staff are provided with training in the Mental Capacity Act, Deprivation of Liberty and the Protection of Vulnerable Adults. Care plans are evaluated regularly and audited by the Manager. One residents care plan, needs and choices is reviewed on a daily basis with nurses, carers and the Chef. Relatives are invited to take part in care plan reviews and assessments are shared with both residents and their relatives. The system for the storage and administration of medication has been reviewed. There is now one medication room for each wing of the house, which provides more space for staff to operate than previously. Local written medication procedures for the home have been developed. A system of different coloured trays was introduced at the time of the last Key inspection, which aims to identify clearly residents who need assistance with eating. Care Homes for Older People Page 8 of 32 A system of questionnaires has been developed for residents regarding their choice and preference in a variety of areas. Regular resident and relatives meetings take place including sub groups for food and activities. Kippingtons now produces a newsletter. Since the last inspection staff have been recruited to all previous vacancies. Staff have been appointed for the Deputy Manager post and twenty four hours nursing and will start work shortly, after which the home will be fully staffed. There are an increased number of bank relief carers. There are now three Activities Coordinators. A second chef and permanent maintenance man have been employed. A new system has been introduced to ensure that all the relevant recruitment checks and documentation is in place. The Manager has developed a new system for staff allocations and named nurses. Walkie Talkies are now used for communication between nurses and senior staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 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 10 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. People are given information about the home and benefit from an opportunity to look around before they make a decision to move in. People benefit from an assessment before they move in, which aims to ensure that the home is suitable to meet their needs. Evidence: People are given written information about Kippingtons before they move in. There is a brochure, statement of purpose and service users guide available. These can also be provided in large print or on a CD. The statement of purpose sets out the aims of the home, which include the provision of long term, short term and respite care for older people with nursing needs. The service users guide provides information to residents about living in the home, such as arrangements for activities and entertainment, meeting religious and spiritual needs, care planning, fees, GP visits, meals and meal times and making telephone calls. It also includes the complaints procedure. There is also a description and colour of uniforms to enable residents to identify the different Care Homes for Older People Page 11 of 32 Evidence: roles of staff more easily. Prospective residents and their relatives can visit the home to look around before they move in. People thinking about moving into Kippingtons are assessed by the Manager to ensure that their needs can be met. This information is recorded with the aim that care plans for the help that people need are developed from this. Pre admission assessments seen at the time of this visit confirmed this. Pre admission information seen contained details of known allergies and the date of the assessment, although the format of the form does not provide a designated space for this. The Manager stated that they would discuss this with the organisation. The home does not provide any intermediate care. Care Homes for Older People Page 12 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. Residents changing personal, health and social care needs are monitored and reflected in care plans and risk assessments. There are systems in place for the administration of medication, which aim to protect residents. Evidence: Individual plans of care for each resident are developed from pre admission assessments. These aim to identify the action required from staff to meet residents personal, social and health care needs. The previous Key Inspection of 16th November 2009 identified that care plan files contained varying levels of completion and not all reflected the changing needs of residents. The Random Inspection of 18th March 2010 identified that the Manager had developed and introduced a new format for care plans which was clear and easy to follow; the Manager stated that they together with the Responsible Individual had updated all care plans. Care Homes for Older People Page 13 of 32 Evidence: During this visit four care plans were looked at and discussed with the Manager. These contained up to date holistic information, which recorded individual personal, health and social care needs, such as daily living skills, skin integrity, cognition, nutrition, personal hygiene, mobility, medication, GP and health care professional visits, social and spiritual preferences, privacy and dignity and biographical information. Risk assessments related to the care provided are recorded. Records of activities are kept separately. Care plans are coded regarding the residents resuscitation status. Daily notes are written by both nurses and carers. The Random Inspection of 18th March 2010 identified that the manager had developed the Resident of the Day review. This system continues to be in place and highlights one residents care plan, needs and choices on a daily basis with nurses, carers and the Chef. Care plans are reviewed and evaluated regularly and these are also audited by the Manager on a quarterly basis. The Manager stated that relatives are invited to take part in residents care plan reviews. Care plans contain records of family contact and show that assessments are shared with both residents and their relatives. Residents views are sought about the care they receive. They are asked about their preferences and consent and this is recorded. The Random Inspection of 18th March 2010 identified that a system of individual preference questionnaires had been developed. This system continues to be in place. During this visit records seen confirmed good detail regarding choice in a variety of areas such as gender preference for carers, opening mail, preferred name, times for rising, retiring and meals and joining in group activities. Questionnaires are repeated, giving the facility to reflect any changes in residents choice and preference. The Manager described plans to introduce a Privacy and Dignity Champion for the home. The previous Key Inspection of 16th November 2009 identified that care plans did not contain any references to the importance of assessments for residents who had impaired mental capacity. The Random Inspection of 18th March 2010 identified that the Manager had developed care plans for mental capacity and decision making for all residents. These continue to be in place. This visit confirmed that care plans have the facility to show where a resident has full capacity or if they have partial capacity, highlighting areas where staff support is needed. Monitoring visits from health care professionals are recorded in care plans. These show that health and social care professionals are accessed with the aim to support staff to meet residents needs, including consultation and referral to medical professionals. The home has a GP who visits the home on a weekly basis. Most Care Homes for Older People Page 14 of 32 Evidence: residents are included in this GP practice or they can choose another practice if they wish. Care plans record visits from and appointments with professionals such as the GP, tissue viability nurse, speech and language therapist, optician and foot care specialist. There are designated staff for liaising with tissue viability and infection control professionals. Staff attend meetings with specialist nurses at the local NHS trust. The continence nurse visits the home. A qualified nurse and carer meet with the dietician every three months. Systems are in place within the home regarding the administration of medication, which aim to protect residents. Currently no residents manage their own medication and all benefit from support from staff to do so. The previous Key Inspection of 16th November 2009 identified shortfalls in the storage and administration of medication. The Random Inspection of 18th March 2010 identified that the Manager and the Responsible Individual had reviewed the systems in place and addressed the issues; a second small room was in the process of conversion to provide an additional medication room which would be competed by 1st April 2010. This visit confirmed that this work has been completed and the second medication room is now in use. There is now one medication room for each wing of the house, which provides more space for staff to operate than previously. The Manager stated that further work on the new medication room is being carried out to make greater improvements. A new system of medication trolleys designated for each floor has been introduced since the last inspection. These are stored in the two medication rooms and a suitable designated area on the middle floor. The latter has the facility to be secured appropriately. At the time of this visit it was observed that this had not been secured to the wall after being used last; the Responsible Individual did this immediately. The temperature at which medication is stored is monitored and recorded. There are designated fridges provided. Air conditioning has been installed in the new medication room as it is a small area. The Responsible Individual stated that temperature in the other medication room is reviewed regularly and that air conditioning could be installed quickly if necessary. Controlled drugs are suitably stored and recorded. Medication Administration Records seen were completed appropriately. These are audited weekly. Records are kept with photographs of residents and signatures of staff for identification purposes. Known Care Homes for Older People Page 15 of 32 Evidence: allergies are recorded. There are staff guidelines for medication prescribed on an if and when necessary basis. The home holds a small amount of homely remedies; there are records of agreement by GPs for administration. The Random Inspection of 18th March 2010 identified that the Manager planned the development of local written procedures for the home to complement the Caring Homes medication policy. This visit identified that this had now been completed and local procedures were available for staff. Qualified nurses administer medication. The Manager stated that medication training was provided on line and staff competency was assessed by the Responsible Individual. Records seen confirmed 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can choose to take part in group activities or pursue their individual interests; they are able to keep in contact with their relatives and friends if they wish. Residents can choose what they eat and are provided with a choice of meals Evidence: At the time of this visit there was a relaxed atmosphere within the home. Residents can choose whether to spend time in their rooms or in the communal areas of the home, taking part in group or one to one activities or pursuing their own interests. There are a range of activities available. Outside entertainment and trips out are also arranged. Parties and events are organised such as Christmas, Halloween and a summer fete. There are three Activities Coordinators who work flexible hours dependent on residents wishes and needs. One spoken with at the time of this visit described some of the activities available as including sing a longs and poetry readings; residents enjoyed a trip out last week to a country house with views and a cream tea; next week there is a trip to Hastings with fish and chips; there is a minibus available for the home on a fortnightly basis and in between times one can be hired. There is an Care Homes for Older People Page 17 of 32 Evidence: activities programme available for residents, forthcoming events include Beatles music for Fathers Day, a quiz and walks. At the time of this visit residents enjoyed the Art Club. Kippingtons now produces a newsletter for residents, their families and friends, which includes information about activities and events. The home now has two cats. Residents can attend church if they wish and ministers are invited to visit on request. Residents are encouraged to keep in contact with their relatives and friends if they wish and visitors are welcome at any reasonable time. Visitors can spend time with residents in the lounges, dining area, conservatory, or residents own rooms. They are able to join residents for meals on request. Meal times are flexible. Residents can choose to eat in the dining room or in their room. Menus are varied and hot and cold options are available. Staff ask residents for their choice of meals each day, which are recorded; an alternative to the main menu can be provided. The manager explained that as part of the Resident of the Day review, the Chef will speak with this individual about their food preferences and discuss any options for improvement. The Chef demonstrated a good knowledge of individual residents different dietary needs such as puree and diabetic food. This information is checked daily with the Manager or senior staff. A system of different coloured trays was introduced at the time of the last Key inspection in November 2009 and continues to be in place. This system aims to identify clearly residents who need assistance with eating. Also since the last Key Inspection, a second chef has been employed. Since the last Key Inspection of November 2009, the Manager has introduced regular resident and relatives meetings. The Manager described how there is also a sub group for food, consisting of residents, relatives, one Activities Coordinator and the Chef. The minutes seen contained good detail of discussions about dietary needs, menu changes, vegetarian preferences, suggestions for improvement, choice of sandwiches, dining room tables, service and atmosphere and staff training in menu pronunciation. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of residents and their representatives are sought regarding the care they receive and how the home is run. Currently a Safeguarding Vulnerable Adults investigation continues to be undertaken. As there have been some outcomes achieved and others not yet reached, the Safeguarding investigation is not yet complete. Therefore these issues have not been included within this inspection process. The Manager of the home has worked hard towards addressing the issues raised and improving standards of care within the home. The home will need to demonstrate that these improvements can be sustained together with the implementation of any recommendations made by Social Services as a result of the Safeguarding investigation. Evidence: Residents views are sought about the care they receive and how the home is run. The Random Inspection of 18th March 2010 identified that a system of individual preference questionnaires had been developed. Those seen contained good detail regarding residents choice and preference in a variety of areas. The Resident of the Day review highlights one residents care plan, needs and choices on a daily basis with nurses, carers and the Chef. Since the last Key Inspection of November 2009, the Manager has introduced regular resident and relatives meetings. This was confirmed Care Homes for Older People Page 19 of 32 Evidence: by minutes seen. There is a written complaints procedure available for residents. This is included in the service users guide and also displayed in the hall area. A record of complaints made to the home, correspondence regarding investigation and any outcomes is maintained. This is held together with any compliments received. One card was seen containing praise for the care provided by the home. Information was seen regarding two complaints. The Manager stated that correspondence regarding one complaint, after it was referred to Caring Homes by the complainant, is held centrally by the organisation. Both complaints are currently being looked at as part of an ongoing Safeguarding Adults Investigation. As full outcomes for the above have yet to be reached, these issues have not been included within this inspection process. Currently a Safeguarding Vulnerable Adults investigation continues to be undertaken confidentially by a multidisciplinary team coordinated by Social Services. This process has been ongoing since September 2009, from which time fifteen Safeguarding alerts have been raised for thirteen residents. The majority of these, with the exception of three, relate to issues raised in September, October and November 2009, of which to date, two alerts have been found unsubstantiated, five partly substantiated and two substantiated. The Safeguarding team continues to investigate five alerts, two from October 2009, one from February 2010 and two raised in March 2010. During this investigation, Kent Social Services have suspended their contract with the home. As there have been some outcomes achieved and others not yet reached, the Safeguarding process is not yet complete. When all outcomes have been reached, the Safeguarding team, coordinated by Social Services will make recommendations and develop an action plan for the home. The Manager of the home was appointed in October 2009, since when they have worked hard towards addressing the issues raised and improving standards of care within the home. The home will need to demonstrate that these improvements can be sustained together with the implementation of any recommendations made as a result of the Safeguarding investigation. The Manager has a good understanding of safeguarding procedures and reporting allegations of abuse. Clear written policies are available including local Kent and Medway procedures. The Manager stated that staff had received training in the Protection of Vulnerable Adults. Records seen confirmed this. As the Safeguarding Vulnerable Adults investigation is not yet complete, these issues have not been included within this inspection process. This inspection does include Care Homes for Older People Page 20 of 32 Evidence: looking at any regulatory issues relating to Safeguarding procedures. All information received since the last Key Inspection is reviewed as part of our inspection methodology. Some of the gathered evidence is mentioned within this report where appropriate. Care Homes for Older People Page 21 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. Residents live in a comfortable, clean and attractive environment. Residents benefit from suitable facilities and equipment, which can help to maintain their independence. Evidence: The home consists of an older building with a large newer extension. All areas of the home seen are well maintained and attractively decorated. Maintenance was being undertaken at the time of this visit and there is a refurbishment programme in place. Accommodation is provided over three floors, all of which can be accessed by lifts. One lift was being repaired at the time of this visit. There are three lounges, one on each floor with a dining room and conservatory on the ground floor. There is also a hair dressing salon. There is a pleasant garden with different seating areas for residents to enjoy. Work has recently begun on a new rose bed that can be seen from the house. There is also a well stocked fishpond and water feature. Some bedrooms have their own decked areas overlooking the garden. Most bedrooms are for single use, although a few rooms are available for people who wish to share. The manager stated that most rooms have en suite toilet facilities and that all rooms within the new building have en suite shower facilities. There is a variety of different size and shaped bedrooms and people are able to choose according to their preference. Residents are able to bring their own furniture when they move in Care Homes for Older People Page 22 of 32 Evidence: if they wish. Residents rooms seen contained many personal items and were homely and comfortable. The home has four communal bathrooms which have baths designed to assist those with mobility problems. One is fitted with a ceiling hoist and mobile hoists can be used in other areas. The beds provided include divan beds, hospital beds and profiling beds, according to the needs and comfort of individual residents. Other equipment available includes grab rails, raised toilet seats, pressure relieving mattresses and cushions, and bed rails with padded sides. There is a staff call system and all external doors are alarmed for residents safety. Radiators have low surface temperatures or are fitted with guards. Hot water outlets are fitted with thermostats, which regulate hot water temperatures which are checked at regular intervals. Each floor has a sluice room and those seen at the time of this visit were clean and tidy. There is no designated sink for hand washing in the laundry room. However, there are hand washing facilities in an adjacent area. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a full staff team who are allocated in sufficient numbers to meet their needs. Residents are protected by the systems in place for staff recruitment. Evidence: The previous Key Inspection of 16th November 2009 identified that delivery of health and personal care is being affected by a lack of permanent nursing staff. The Random Inspection of 18th March 2010 identified that, with the exception of the Deputy Managers post and twenty four nursing hours, the home had no other staff vacancies. During this visit the Manager stated that a Deputy Manager had now been appointed and would start work in June 2010 and the vacancy for twenty four hours nursing would be filled shortly after a new employee completed their induction training. At the time of this visit there was a relaxed atmosphere in the home and sufficient staff on duty to meet the needs of residents. Currently there are thirty eight residents accommodated. The manager stated that a bank of relief carers had been developed with two new carers shortly to be added to this. There is an on call system in place. Since the last inspection the Manager has introduced a Walkie Talkie system for communication between nurses and senior staff. Care Homes for Older People Page 24 of 32 Evidence: The Random Inspection of 18th March 2010 identified that the Manager had developed a new system for staff allocations. This visit confirmed that this system continues to be in place. Staff are rostered for the same wing of the home and there are named nurses and carers for individual residents, which aims to improve continuity of care for residents. Records of staff duty rosters and allocations were seen. The manager stated that there are photos of residents keyworkers in their rooms; the Service users Guide includes a description and colour of uniforms to enable residents to identify the different roles of staff more easily. There are three Activities Coordinators who work flexible hours dependent on residents wishes and needs. Auxiliary staff are employed for kitchen, domestic, maintenance and administrative duties, including reception by the main entrance. The Manager stated that since the last Random Inspection a second chef and permanent maintenance man have been employed. During this visit the procedures for staff recruitment were looked at. The Random Inspection of 18th March 2010 identified that a new system had been introduced to ensure that all the relevant checks and documentation was in place. Three staff files were seen during this visit. These showed appropriate pre employment checks, such as Criminal Record Bureau checks, references, identification, a full employment history including any gaps, right to work in the UK information and a record of interview questions and answers. The manager described the processes for staff training as including a Training Coordinator who visits the home on a weekly basis; courses are provided from a variety of sources including external agencies, the organisation, computer E learning and within the home. Professional development pathways are available for staff. The Manager said that all new staff who undertook induction training; Common Induction Standards, which link into National Vocational Qualifications are used together with in house training and orientation. Staff are provided with a range of ongoing training, which is designed to meet service users needs. Mandatory training includes moving and handling, health and safety, infection control and first aid, which includes resuscitation. Additional more specialist training can be arranged for issues such as diabetes, epilepsy, dementia care or nutrition. The Manager stated that all staff have received training in the Protection of Vulnerable Adults. Medication training is provided on line and staff competency is assessed by the Responsible Individual. Records seen confirmed this. The previous Key Inspection of November 2009 identified that it was unclear if there were policies and procedures in place regarding the Mental Capacity Act and Care Homes for Older People Page 25 of 32 Evidence: Deprivation of Liberty; only the manager was trained in understanding and applying this legislation. During this visit the Manager stated that all staff had now received this training. There are designated links for tissue viability and infection control with protected time for staff to attend meetings with specialist nurses at the local trust. The continence nurse visits the home. A qualified nurse and carer meet with a dietician every three months. Many of the care staff currently employed are qualified nurses in their country of origin. The manager explained that these qualified carers together with carers who have a National Vocational Qualification totalled 65 per cent of the staff team; carers with a National Vocational Qualification alone made up 28 per cent of the staff team. All PIN numbers for qualified nurses are checked as up to date and records are maintained. Records seen confirmed that training has taken place with further courses booked. Care Homes for Older People Page 26 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 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 run by an experienced and qualified Registered Manager. Residents views are sought about the care they receive and how the home is run. There are systems in place which aim to protect residents financial interests. Staff are supported by regular supervision. Records indicate the testing and maintenance of systems and equipment within the home, although the health and safety of residents may be improved by addressing recommendations made by the Environmental Health Officer regarding the kitchen floor. Evidence: The previous Key Inspection of 16th November 2009 identified that the Manager was appointed in October 2009 following a period of temporary management. The Random Inspection of 18th March 2010 identified that the Manager was registered with the Commission in March 2010. The Manager has previous experience of running a care home and is a trained nurse. Currently the Responsible Individual works solely at Kippingtons. During this visit the Manager explained that a Deputy Manager had been Care Homes for Older People Page 27 of 32 Evidence: appointed and would start work in June 2010. The organisation has a system in place to assess the quality of care that the home provides. Annual quality assurance questionnaires are sent to residents, relatives and health care professionals. Audits and reviews of documentation, medication, care plans and health and safety take place; the Responsible Individual monitors the home and a report is provided on a monthly basis. The Manager notifies the Commission of any adverse events. Residents views are sought about the care they receive and how the home is run. The Random Inspection of 18th March 2010 identified that a system of individual preference questionnaires had been developed. Those seen contained good detail regarding residents choice and preference in a variety of areas. The Resident of the Day review highlights one residents care plan, needs and choices on a daily basis with nurses, carers and the Chef. Since the last Key Inspection of November 2009, the Manager has introduced regular resident and relatives meetings. The Manager described how there are also sub groups for specific issues such as the summer fete and food. This was confirmed by minutes seen. Kippingtons now produces a newsletter, which includes forthcoming activities and events. Staff receive regular one to one formal supervision sessions. Since the last Key Inspection of November 2009, the Manager has developed a supervision structure within the home. This was confirmed by clinical supervision and appraisal records seen. Staff meetings are held every two months. Small amounts of cash are held securely on behalf of some residents on request. The systems in place for two residents were checked; cash tallied with transaction records and receipts. Audits are undertaken. There are a range of written policies and procedures available as guidance for staff. The previous Key Inspection of November 2009 identified that there was no policy in place regarding resuscitation. This has since been developed and introduced together with those for the Mental Capacity Act and Deprivation of Liberty. This visit identified that these documents are available for staff, although they are not yet placed within the organisations Care Manual. Because of this, these policies are not given a corporate identity or dated; the latter making future review more difficult to evidence. The Responsible Individual stated they would inform the Commission when these polices become part of the organisations Care Manual and are dated. The Provider is recommended to ensure that polices and procedures for resuscitation, the Mental Capacity Act and Deprivation of Liberty are dated in order to evidence review clearly. Care Homes for Older People Page 28 of 32 Evidence: The previous Key Inspection of November 2009 identified that it was unclear if there were policies and procedures in place regarding the Mental Capacity Act and Deprivation of Liberty; only the manager was trained in understanding and applying this legislation. During this visit the Manager stated that all staff had now received this training. Records seen confirmed that training had taken place. A number of records have been looked at as part of this inspection and these have been mentioned within this report where appropriate. Accidents and incidents are recorded appropriately. Records seen at the time of this visit indicated the testing and maintenance of systems and equipment within the home, which was confirmed by discussion with the maintenance man. One lift was being repaired at the time of this visit. The premises and the accommodation are monitored with the aim that potential hazards to the health and safety of residents can be identified and addressed. The last visit from the Environmental Health Officer was in October 2009 where some recommendations were made regarding the kitchen. This included replacement flooring for a worn area in front of the dishwasher that could potentially be difficult to clean. This visit identified that this had not been addressed. The Manager explained that this had been requested from the organisation and they were waiting for this to be completed. The last visit from the Environmental Health Officer in October 2009 also noted some debris on the kitchen floor behind appliances. During this visit it was observed that a floor area adjacent to the dishwasher was stained and contained some debris. A requirement has been made. Care Homes for Older People Page 29 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 30 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 38 16 The registered person shall, after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. In order to protect service users and ensure the maintenance of infection control, areas of flooring within the kitchen must be improved following recommendations made by the Environmental health Officer in October 2009. 09/07/2010 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 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. 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