Care Home: Kirkdale Care Centre and Rebecca Posner Unit

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What the care home does well The home is welcoming of visitors and the atmosphere is relaxed and friendly. Contact with family and friends is encouraged and a most residents have regular visits at the home, and go to their relatives for short visits. Residents say that the staff are friendly and helpful, and that the manager is at the home regularly, and listens whenever they have any problems. The staff and manager are quick to involve relevant health professionals and social services whenever their support is needed. Health care needs are wellmet and residents commented that the food is good and they are generally happy that they get food they like. The manager is experienced and well regarded by residents and staff. What has improved since the last inspection? The home has a lot of stairs and steps and residents who have mobility support needs may be at risk of falling. The home has now done a risk assessment for each resident who has a mobility support need about using stairs and risk of falling. New people referred to live at the home are also now risk assessed about using stairs and this is used to decide whether the home is appropriate for them. Information recorded by staff about residents as part of the daily records is now more detailed about things like their mood, activities they`ve been involved in, mental health and dementia related issues, and this information can be used to review care plans. Activities for residents have improved and the full time activities coordinator is also trained in providing suitable safe exercise sessions for residents. Residents say that there are more activities happening that they enjoy. The home has taken part in an outdoor activities project and has received very positive acclaim from residents and from the project organisers for the effort they made to involve residents in these activities. Care staff now have a better understanding of the medication for the residents for whom they most often provide support, and this helps staff to better understand how it affects residents so that they can contribute to medication reviews. The home has assessed staffing to show that there are enough staff available to fully support residents. There is also now always a minimum number of staff available to provide care and staffing levels don`t fall short of the minimum number on each floor of the home. Staff are now always CRB checked before starting work at the home. This means that the home is sure that new staff are safe to work with residents. All Staff now have at least 3 paid days training and usually more than that. There is now a training plan for the home, which helps to make sure that the most important training needs for staff are met. Staff are now supervised more regularly and say that they feel supported to do their jobs. The home has been redecorated on the ground floor and second floor and six residents rooms have been redecorated. There are plans to redecorate the first floor and the rest of the resident`s bedrooms. What the care home could do better: The home should include in care plans for each resident a pen picture of what dementia means for them. This should be used to help organise suitable activities at the appropriate time for each of these residents. The exercise opportunities offered to residents should be spread out more throughout the week so that if they are missed another opportunity will arise soon. Staff should be encouraged to reschedule activities when they are missed if this is appropriate for the resident. This will enable more consistent opportunity for residents to do things they like to do. The home most ensure that when the medication is returned to the pharmacist that there is a clear signed record to evidence that this has happened. This will ensure that medication is properly documented and tracked. Personal care plans for residents should include guidance for staff in how to support residents to maintain their independence, especially on being supported in bathrooms and when getting dressed, and especially for residents who find it difficult to move independently. The home should ask residents, relatives, and commissioning agents about whether they would like to see a member of staff support and should they need to go to the hospital, so that they will feel safer and more confident during hospital admissions. The home should consider expanding the pool of bank care staff so that more staff are available on emergencies arise. Although the current system for staff at the home to fill in during emergencies does not currently present any serious problems, and larger pool of staff would provide better access to getting support quickly when needed, and would lessen pressure on the current staff team. CARE HOMES FOR OLDER PEOPLE Kirkdale Care Centre and Rebecca Posner Unit Kirkdale Care Centre 258 Kirkdale Sydenham London SE26 4NL Lead Inspector Sean Healy Unannounced Inspection 9th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kirkdale Care Centre and Rebecca Posner Unit Address Kirkdale Care Centre 258 Kirkdale Sydenham London SE26 4NL 020 8659 9004 020 8776 7223 fiona.lydon@excelcareholdings.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Rinacrest Limited Fiona Ann Lydon Care Home 63 Category(ies) of Past or present alcohol dependence (0), registration, with number Dementia (0), Dementia - over 65 years of age of places (0), Mental disorder, excluding learning disability or dementia (0), Old age, not falling within any other category (0), Physical disability (0), Physical disability over 65 years of age (0) Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 20 patients (accommodated in the Rebecca Posner Unit at Kirkdale Care Centre) elderly persons aged 60 years and above (female) and 65 years and above (male) with a mental health disorder 42 residents (in Kirkdale Care Centre) persons aged 65 years and above, and persons aged 60 years and above who suffer from a past or present alcohol dependence persons aged 60 years and above who are physically disabled 1 may have past or present alcohol dependence and 1 may have a physical disability This home is registered for 42 persons of whom up to 42 may be old age, up to 42 have dementia 27th September 2007 Date of last inspection Brief Description of the Service: Kirkdale Care Centre and Rebecca Posner Unit, is a care home with nursing for a maximum of 63 older service users, who are physically frail or have dementia. The overall stated aim, shared with other homes run by the same provider, is that of offering care in a home from home setting, recognising and meeting individual needs. The underlying philosophy is that of promoting users’ rights to privacy, dignity, security, choice and fulfilment. The registered provider is Rinacrest Limited, a company associated to an organisation called ‘Excelcare’, who run over thirty homes in England. A director, to whom all the staff are ultimately accountable, directs the service. The day-to-day running of the home is delegated to a care manager, who works full time at the home and who leads a team of staff. Accommodation is provided in a large building, divided into three smaller units, one on each floor. The top floor unit provides nursing care. There is a lift. Bathrooms and toilets are located on each floor. None of the bedrooms have en-suite facilities. There is a large back garden. There is provision for parking at the front of the premises. The front and back doors are accessible to people in wheelchairs. The premises are located on a main road close to the centre of Sydenham. The area is served by public transport and has a selection of shops. The provider’s email address is: fiona.lydon@excelcareholdings.com Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 5 Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. The recent CSCI report is kept on display in a bookrack on each floor of the building, and is discussed in meetings with relatives. At 9th July 2008, the homes fees range from £550- per week for residential care to £723- per week for public or private nursing care, which covers all of the homes charges including food. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality Rating for this service is 2 Star. This means that the people who use this service experience Good quality outcomes. The inspection was unannounced and took place on 9th July 2008. It ended on 25/7/08 following receipt of information from residents and their families about their views of how the home is managed. The registered manager and assistant manager facilitated the inspection. The inspection also included separate discussion with a commissioning authority who contract services from the home and who also carry out annual audits of the care provided. Relevant comments are also included in this report. Two care staff, two nurses, the activities co-ordinator, and the assistant manager were interviewed and their comments are included in this report. Informal discussion took place with two other care staff. Five staff employment files were examined to check that they had been properly recruited, trained and supervised. 12 residents gave their views on the home through speaking with me and through completing inspection questionnaires. Six residents files were examined. Resident’s surveys were distributed and comments are included in the report. Two relatives gave their views and experiences of how the home is managed. The homes performance in managing adult protection and safeguarding issues for resident’s team were also considered. There were 15 residents’ vacancies but many of these beds are in double rooms, which are now used as single rooms. The inspection involved a tour of the premises and examination of a range of management documentation. What the service does well: The home is welcoming of visitors and the atmosphere is relaxed and friendly. Contact with family and friends is encouraged and a most residents have regular visits at the home, and go to their relatives for short visits. Residents say that the staff are friendly and helpful, and that the manager is at the home regularly, and listens whenever they have any problems. The staff and manager are quick to involve relevant health professionals and social services whenever their support is needed. Health care needs are well Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 7 met and residents commented that the food is good and they are generally happy that they get food they like. The manager is experienced and well regarded by residents and staff. What has improved since the last inspection? The home has a lot of stairs and steps and residents who have mobility support needs may be at risk of falling. The home has now done a risk assessment for each resident who has a mobility support need about using stairs and risk of falling. New people referred to live at the home are also now risk assessed about using stairs and this is used to decide whether the home is appropriate for them. Information recorded by staff about residents as part of the daily records is now more detailed about things like their mood, activities they’ve been involved in, mental health and dementia related issues, and this information can be used to review care plans. Activities for residents have improved and the full time activities coordinator is also trained in providing suitable safe exercise sessions for residents. Residents say that there are more activities happening that they enjoy. The home has taken part in an outdoor activities project and has received very positive acclaim from residents and from the project organisers for the effort they made to involve residents in these activities. Care staff now have a better understanding of the medication for the residents for whom they most often provide support, and this helps staff to better understand how it affects residents so that they can contribute to medication reviews. The home has assessed staffing to show that there are enough staff available to fully support residents. There is also now always a minimum number of staff available to provide care and staffing levels don’t fall short of the minimum number on each floor of the home. Staff are now always CRB checked before starting work at the home. This means that the home is sure that new staff are safe to work with residents. All Staff now have at least 3 paid days training and usually more than that. There is now a training plan for the home, which helps to make sure that the most important training needs for staff are met. Staff are now supervised more regularly and say that they feel supported to do their jobs. The home has been redecorated on the ground floor and second floor and six residents rooms have been redecorated. There are plans to redecorate the first floor and the rest of the resident’s bedrooms. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed decision about whether to live at the home. All residents do have fully completed assessments of their care needs in place before coming to live at the home. Intermediate care is not provided. EVIDENCE: The home has a Statement of Purpose of Service User Guide, which has been revised in 2007. These documents accurately described the services and accommodation to be provided by the home. At the last inspection there had been some issues, which had arisen regarding the safety in using the various stairs, and steps in the home for residents who have mobility problems. It was recommended that a comment be made in the homes Statement of Purpose to highlight this issue, and emphasises the need to risk assess all individual referrals who have been assessed as having mobility support issues. This has Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 11 now been done. The home now has included this information in the Statement of Purpose so that any prospective residents will be aware of the potential problem with the use of stairs and the home now routinely includes risk assessments in the use of stairs as part of the standard referral assessment system. Residents who are then assessed as high risk in the use of stairs are not admitted to the home. This now adequately protects new residents from risk in using the stairs. I examined six residents files and these showed that each had an assessment of their care and support needs which had been provided by social services, and that separate more detailed care assessments had been carried out by one of the home before a decision was reached to provide a service. These were detailed and usually carried out by the Manager or Deputy Manager, who is a trained nurse. Information was comprehensive and included residents’ personal data; medication; medical history; activities of daily living (e.g. mobility, communication needs, continence, sleep pattern, personal hygiene needs); mental state, skin integrity personal safety issues, communication needs, eating and drinking support and sensory support needs. There is also an assessment statement regarding the residents’ abilities and wishes concerning self-medication, management of personal finances and benefits and whether bedside rails are necessary for support. The home does not provide intermediate care. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health, personal and social care needs are included fully in their care plans. There are good health care plans for residents to meet all of their health care needs. Medication administration is generally good but residents are not fully protected by the homes medication practices. Arrangements for personal care support are good and residents are treated with respect. EVIDENCE: There was a requirement made at the last inspection for the home to include social leisure and religious and cultural care needs in all residents care plans. This is now been done. There is now a permanent dedicated activities coordinator employed at the home who meets with residents weekly to discuss their activities. Each resident has an individual activities plan covering each week. The weekly meeting with the coordinator is recorded in appropriate notes kept showing the activities the resident wants to take part in. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 13 Six residents files were examined. These showed that residents have comprehensive personal care plans individual to their identified needs, and that there are a range of appropriate health care professionals involved in providing healthcare support. These files and the homes showed that there is a high level of support required for bathing/toileting, dressing, continence management and eating. In addition the majority of the residents have dementia support needs and about a third of all residents have sensory support needs needing consideration in care planning for hearing and sight specialist support. I found that these areas were included in assessments and had been transferred into care plans and that these plans were being reviewed monthly for all files examined. Discussion with residents and relatives showed that they are being asked to be involved in care plan reviews. However although dementia is specified in care plans where residents have the support need, the care plans do not adequately describe how the dementia affects individual residents. For example whether or not the person is more able to concentrate and understand information at different times of the day, or indeed different times of the month or year, and whether or not it is better to offer exercise at particular times more suitable to individual understanding. It is recommended that as part of the care planning a pen picture of what dementia means to each individual resident be included, in order that staff may be better able to judge when to offer activities. (Refer to Recommendation OP7) There was a requirement made at the last inspection for the home to assess all current residents regarding risk in the use of stairs. This is now been done for all residents. A number of the risk assessments examined showed high risk in using stairs, but a risk was reduced to low risk as the residents involved were living on the ground floor are and will comply with not using the stairs. It is recommended that the risk assessments include a conclusion section stating whether the risk is now acceptable for these residents, and whether it is required that they reside on the ground floor in order to maintain their safety. (Refer to Recommendation OP7) The files examined showed that risk assessments are being reviewed at least every six months, and that risk in the use of stairs is now being assessed as part of the admissions process. There was a requirement at the last inspection for the home to ensure that the quality of written handover information in daily records be improved in order to better inform the planning and review process for residents. This is now been done. Examination of the handover information for six residents now shows good detail regarding resident’s health well being and activities. However a number of these records showed that when activities were missed there was no mention of rescheduling these activities in order to ensure the residents did not miss out on opportunities. For example one resident had missed out on his the exercise sessions, which were scheduled for Monday and Tuesday, and there were no clear alternatives for exercise for this resident for the rest of the Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 14 week. It is recommended that residents exercise opportunities be spread out more over the week, and that they be encouraged with staff to reschedule activities when opportunities for these are missed. (Refer to Recommendations OP7) The homes assessment process involves assessing a full range of healthcare needs prior to admission to the home. Care plans examined showed that these healthcare needs are transferred from the assessment onto the care plan and that range of health care professionals are involved in providing support at the home. Six nursing staff are employed who are largely responsible for managing the care for residents with nursing care needs. All residents are registered with a GP and district nurses, dentists, chiropody and tissue viability nurses attending the home regularly. The GP visits the home on a weekly basis or when required. The manager described good support from the Care Homes Support Team for the nursing floor in the form of regular visits and training for staff. All other health professionals visit routinely or when needed and these visits were recorded in service users’ files. Each service user’s file contained an individual risk assessment covering areas such as risk of falls and risk of pressure sores. There was a requirement made at the last inspection for care staff at the home to have adequate knowledge of prescribed medication in order that they be better equipped to monitor the effects on residents. This has now been done and the home now provides medication awareness training for all care staff. Medication Administration Record (MAR) charts are being used on all 3 floors, and recording is good. Medication is being safely stored, and administration is allocated to the nurse in charge on each floor. Care staff who administer medication on the two residential floors have undertaken medication handling distance learning. Staff carry out medication audits on each other’s units three times a week and action is taken on any issues picked up. There is a record of items administered by district nurses. The application of external products and food supplements is also recorded. The homes medication policy was reviewed in April 2008, and prescribes how staff should behave regarding medication management issues. The home does administer controlled drugs and these are stored appropriately in a metal locked cabinet. Medication is generally reviewed every six months but one of the residents medicines examined showed that the controlled drugs that he was being administered had not been reviewed by the GP in eight months. Is recommended that the review of this resident’s medication be brought to the attention of the GP. (Refer to Recommendation OP9) Medication is delivered by the pharmacists every 28 days and returns have been recorded showing the quantity and date of medication being returned. However this records is not being signed by the staff who have returned medication, and the pharmacist does not leave a records of the medicine Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 15 returned or provide a signature showing that they have received medication. The home must show evidence that the medication has been returned to the pharmacists and that it has been received by them. (Refer to Requirement OP9) The home is registered for providing support for up to 63 residents. The Annual Quality Assurance Assessment shows that all of the residents have some level of Dementia and that and that between 32 and 36 residents need help with bathing and dressing. All of the files six residents files examined showed a personal care plan is in place and clearly describe when support is required in bathing/toileting and dressing. However while a number of care plans examined stated the resident should be “allowed to do what she can for herself”, these care plans did not clearly show the areas in which each resident is able to help themselves in personal care tasks. Given the high number of residents requiring personal care support it is important in the interests of preserving the dignity and independence of each resident that personal care plans be more explicit about the areas in which each individual resident are able to do thing for themselves. The personal care plans for residents who have mobility support needs, and for those residents, who cannot communicate their needs verbally, must include guidance in how to ensure that they are enabled to do as much as they can for themselves in order to maintain their independence. (Refer to Requirement OP10) Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s approach to activities has improved with a full time activities co-ordinator ensuring activities are tailored to meet the needs of individuals. Residents maintain contact with families, friends and others from the community, and are supported to exercise choice and control in their lives. Residents are provided with a choice of varied and nutritious meals EVIDENCE: The home is a member of National Association of providers of Activities for older people in Care Homes (NAPPA). There is a full time activities co-ordinator employed, and a programme of activities is offered on a daily basis. The activities coordinator has now been trained to carry out physical exercise with residents, and he has close links with a local activities group, which is chaired by the Care Home Support Team. The activities co-ordinator has drawn up an assessment and activities programme for residents. He is also able to spend time with individual service users finding out first hand whether things are improving for them. Six residents files examined showed that each had a weekly activity plan in place showing activities such as: Gentle exercise, walking in the garden, games and puzzles, sing-along sessions, reading the Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 17 newspaper, craft, hand and nail care, and group discussion. The home took part in a week-long Borough-wide “ Breath of fresh air” activities programme, and produced a comprehensive activities schedule which focused on getting residents out in the open air. Activities included car washing, hanging out washing, walks to local shops and outings for coffee and lunch, drama and entertainment in the garden, and planting flowers. The staff and service users I interviewed said they really enjoyed the week of activities and would like to see it repeated. The home has set an objective for itself now to provide a similar week of activity each month weather permitting. All residents and/or their families complete a life review and social care diary,often with a member of staff. All residents have an individual activity plan,a leaflet is available detailing planned major activities, celebrations, and planned outings for the year. Activities offered include armchair exercise, knitting group, card games, dominoes, bingo, hand and nail care, art and craft and visiting musical performers. Some trips out had also been offered. Regular entertainers visit the home, and church ministers visit from the Catholic Church and from the 7th Day Adventist church. On the days of the inspection about 12 residents took part in an exercise session put on by the activities coordinator. All seemed to enjoy this and three residents said they really liked it. There is a private and pleasant space for residents to receive visitors in addition to their bedrooms, situated in the basement. Residents are able to choose items of their own to bring into the home, residents I spoke to confirmed that they are offered choice in areas such as what time to get up and go to bed and what food they wish to eat at meal times. Two relatives said that they are very happy with the approach of the new management in getting to know residents. They said the manager is always available and has helped to improve activities at the home. All residents have their own room where they can receive visitors in private,a family room is also available. Residents are encouraged to bring personal possessions into the home,including furniture and bed linen. The home operates a four-week rolling menu, and the meals offered appeared to be varied and nutritious. They also included meals for vegetarians and people from other cultural backgrounds. Residents are assisted to complete a form every day to indicate their choices of meals. Residents I spoke to were happy with the meals provided. Comments included “the food is good”, when speaking with residents. Three cooked meals are provided daily, and a cooked or continental breakfast is available. There are always two cooked options available for lunch and salads are provided even if they are not on the menu. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s comments and the complaints record show that complaints are taken seriously. The home’s policies, procedures and action taken in relation to incidents, show that residents are protected from abuse. EVIDENCE: The complaints procedure is included in the service users guide and located at various points around the building. This policy was reviewed in 2006 and clearly directs staff in how to respond to complaints received. Three staff interviewed and were able to describe how to responsibly deal with any complaints made. Nine written inspection survey responses were received from residents and all of these showed that they were aware of how to complain and also the majority of these specifically said that the homes manager is always available to speak to if they have any problems. Six residents files examined showed that they had not made any complaints in the past 12 months. One complaint was received from a relative of a resident regarding the quality of care provided. This was fully investigated by the home in liaison with social services and found to be not substantiated. One written compliment was received from a relative, which was highly complimentary about the quality of care, the attitude of staff and the Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 19 management of the home. Two other residents specifically asked me to include their comments that the staff are very good and that the management has improved the standard of the home. This view was also expressed in all of the nine service user inspection surveys received. The home’s Adult Protection policy is up to date, and three staff files examined showed that they had received appropriate training in the protection of vulnerable adults, and four staff interviewed showed a good knowledge of how to report and record any allegations made. There have been seven Adult Protection investigations involving the Adult Protection team in Lewisham since September 2007. These cases have now been investigated and closed and at the time of inspection there were no current adult protection cases in progress. The adult protection concerns investigated included the following: 1. 2. 3. 4. 5. 6. Quality of care Unexplained bruising Attitude of staff Allegation of assault Medication management Resident leaving the home without support All of these allegations were reported appropriately by the home to CSCI and to the social services safeguarding team. All were appropriately and thoroughly investigated in liaison with social services and good written information was kept showing the investigation process and findings for each allegation. The home took measures in each case to make adjustments to practices and to inform staff regarding areas to focus on to better protect residents. In addition the home has taken measures to ensure that residents who may be vulnerable in using the various stairs in the home are better protected. This has been done by risk assessing all current residents and identifying those at risk, and ensuring they are safe, and by introducing risk assessments in the use of stairs for all new residents referred before taking a decision to accept the referral. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is safe and generally well maintained, but there are some further refurbishments needed to make it comfortable for all residents. The home is generally clean pleasant and hygienic. EVIDENCE: The home is located in Sydenham, close to shops facilities and good public transport links. It is an older property with bedrooms and communal sitting and dining space arranged in three separate units over three floors. The provider has reduced the number of rooms being used as shared rooms to only one room shared by a married couple. Previously having introduced a visitor’s room in the home, this has very much improved the private space for service users. This has improved the homes ability to best provide for the residents Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 21 privacy, dignity and choice. A main sitting room/dining room space was enlarged last year to provide better comfort and privacy for residents. At the last inspection a requirement was made to have a range of repairs carried out in the home. This has now been done and the following improvements have been made in the home: 1. The size of opening space on restricted windows in residents bedrooms have been changed to ensure residents cannot exit through these spaces. 2. Work has been carried out on all residents’ bedrooms to ensure residents or their visitors can easily open them now if they need to air their room. 3. A handrail has been secured between the first and second floor and walls in the area redecorated 4. A digital keypad lock has been fitted to the outside front door in order to safely ensure that residents who need it have the right support from staff or relatives 5. The ground floor and second floor of the building have been completely redecorated and a new kitchenette and dining room have been installed 6. New non slip flooring ahs been fitted in all hallways and new larger lights have been fitted in hallways to improve the light in these areas 7. Electrical cables have been concealed and hallways and stairs have been brightly decorated. 8. A programme of bedroom refurbishment has been started and six residents bedrooms have been redecorated. The homes manager and property manager said that plans and funding are in place to continue with this work throughout the home. This shows a significant improvement to the environment in which the residents live. Completion of this work will take some time given the size and age of the building. The commitment now being shown to address the issue of improving the fabric of the home is very positive and when completed will bring the environment up to a good standard. The first floor remains an area for improvement and this is included in current plans. The home was clean is maintained to a high level of cleanliness and hygiene. As at the last inspection the homes maintenance team are very quick and efficient to respond when repairs are required. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are now met by the numbers and skills of staff and they are in the safe hands of trained and qualified staff. Residents are protected now by the homes recruitment practices. EVIDENCE: I examined recruitment, selection induction and training information on five staff files. I interviewed two nursing staff and two care staff and had informal discussion with several other care staff. I also had in depth discussion with the registered manager and deputy manager. One of the main commissioning agents also gave their view of the issue of staffing in the home. The following are my findings from these activities: The home now has a stable compliment off staff who receive regular training. Agency staff are not used but have a bank of staff who work regularly within the home are used to provide emergency support when staff are off sick or on training or annual leave. Duty rotas are completed three weeks in advance and are displayed in reception showing the manager on duty and the persons in charge on each of the three floors throughout a twenty four hour period. Staffing levels are: Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 23 1. On the ground floor: One senior and two carer assistants throughout the day and evening and one senior and one care assistant at night 2. On the first floor: One senior and two carer assistants throughout the day and evening and one senior and two care assistant at night 3. On the 2nd floor: One nurse and two carer assistants throughout the day and evening and one nurse and one care assistant at night 4. The deputy manager has 12hrs a week of supernumary time divided across the three floors and responding to requests for help or emergencies. The staffing levels remain the same as at the last inspection, but show a small increase in that the deputy manager provides the extra support described. At the last inspection a requirement was made to ensure that during emergencies such as hospital admissions for residents, that staffing levels be maintained at safe minimum levels. This requirement has now been met in the following way: The home has also taken a decision to not consistently provide a familiar worker to provide support for a resident when being admitted to hospital, as was the case previously. This decision was taken in order to protect the minimum staffing levels from falling when hospital admissions happen. While this does ensure safe minimum staffing levels are maintained, the consultation process of the inspection shows a strong feeling that this falls short of expected best practice, and does not allow the homes management the flexibility to make a judgement to provide this support. It is recommended that the home consult with commissioning agents, service users/families and their own staff to gain a fuller understanding on their views as to whether this is the desired service needed and to give them feedback on their findings and recommendations as part of the homes quality assurance consultation system. (Refer to Recommendations OP27) The home’s emergency support is solely provided by a bank of staff who already work within the home. This limits the homes ability to provide for shortfalls in staff during emergencies as described above, or during periods of staff sickness. It is recommended that the home and the registered provider examine options as to how the bank of staff available can be increased beyond the limitations of what can be provided solely by the current staff to better cater for these unforeseen situations. (Refer to Recommendations OP27) There was a requirement made at the last inspection for the home to carry out a staffing analysis for the first and second floors to ensure that staffing levels do not fall below safe minimum levels and that staff are able to carry out their expected contracted duties. This has now been done and the manager said she is confident from the results that staff are able to fulfil all of the tasks expected of them without impacting on the care provided. Overall the staff morale at the home has much improved and good levels of training and supervision are now provided. It remains the case that staffing levels on the first floor, though adequate in providing safe care for residents, do not provide much additional Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 24 time for staff to engage residents many of whom require high levels of staff time to engage in meaningful activities and communication. It is recommended that the home continue to closely monitor the staff time available for interaction with these residents to meet their social needs. (Refer to Recommendations OP27) All staff in the home are over the age of 18 years old and a qualified nurse is on duty 24 hrs a day. Each floor has a dedicated domestic to ensure each area is cleaned daily. There is a separate laundry worker. A full time activities coordinator is in post and we take students on placement. Recruitment practices are detailed with good records of interviews, induction, training and supervision now being kept. There was a requirement made at last inspection for the registered provider to ensure that enhanced CRB checks are completed for all staff before the start employment at the home. This requirement is now met. All staff files examined showed that none are employed prior to receipt of an enhanced CRB and two references all staff files are checked by our HR Department prior to employment commencing. All employees receive an induction and a copy of the staff handbook, which details the code of conduct and personnel policies and procedures. There was a requirements made at the last inspection for the home to provide evidence that all staff receive a minimum of three paid training days annually. This requirement has now been met. Staff training has improved significantly with all staff inductions happening consistently, all files examined had more than three days training included in the previous year. The manager and all staff interviewed said that they are paid for attending these training days. 22 of the 26 care staff employed now are qualified to NVQ LEVEL 2/3, and one other is completing the course. The nursing staff interviewed commented that they feel care staff are experienced and are working well as a team. In response to a requirement made at the last inspection to ensure that care staff have adequate knowledge of prescribed medication, the home now provides medication awareness training for all care staff. Mental Capacity Act training is now also included in the training plan for the home. All care staff now have had dementia care training and the activities co-ordinator and a number of other staff have had training in how to safely provide physical exercise for residents. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified, experienced and competent to run the home. Some good quality assurance systems are in place, which ensure that the home is run in the best interests of the residents. Resident’s financial interests are being effectively safeguarded. Staff are supervised and the home has adequate health and safety policies and systems in place. EVIDENCE: The registered manager is a qualified nurse (RMN), with substantial experience in care and management. She needs to enrol on the NVQ4 course in care, and plans to do this by January 2009. She started in post one and a half years ago and has now been registered by CSCI. The manager is now in full control of all care and employment decisions taken and is fully active in the management of Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 26 complaints and safeguarding issues arising at the home. Staff, residents and a health care commissioner who visits the home annually say that she has made positive changes in how the home is managed and all of the ten residents who responded to the CSCI inspection survey say the home is well managed, and that the manager is always available to listen to them. Residents whom I spoke to said that they feel they can easily speak with her and see her regularly helping residents. The manager is supported by an assistant manager who also holds an NVQ Level 4 in care and management, and by an administrator, which greatly strengthens the management in the home. The manager has recently received an award from “Care Aware” for her work in community care. The company has a quality department that provides questionaires which are sent out to the home twice a year. One is a food survey and one is a general questionaire seeking views on more general issues around the home the quality department collate the results and send them back to the home which the manager then incorporates into the homes action plan which is reviewed monthly. Residents are asked for their views on the entertainment that is provided compliments and complaint forms are available and these are evaluated to see how they can be incorporated improvements in the services that are provided. The last residents questionaire was conducted in January 2008 and the results were published and made available at reception. The home is visited by a regional manager monthly who carries out unannounced visits and provides the home with a report on findings. 6 monthly audits are carried out by the service development manager. Monthly night audits are also conducted and care plans,medication and pressure sore reporting is also audited monthly. There is now an annual development plan in place showing plans for development of the homes environment as a main feature. The next objective here is for improvements to the fabric and décor of the first floor following improvements already made ot the ground floor and second floor. Eleven residents have their bank accounts facilitated by the home by agreement with these residents and their families. These residents receive regular statements about the money held on his behalf by the provider. There was requirement made at the last inspection for the home to ensure that all staff receive at least six formal supervisions annually with their line manager. This requirement was met. All five staff files examined showed consistent supervision is happening between each staff member and their line manager at least every three months, in accordance with a supervision plan which the home has now put in place. Each staff now has a training plan with a record of training received, and the home has now started to provide annual appraisal for all care and nursing staff. Health and safety is generally given due care and attention by the homes management. There is a health and safety policy and appropriate systems being used for training staff, checking fire equipment, storing dangerous Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 27 liquids and substances, carrying out risk assessments, and doing regular health and safety checks within the home. The fire officer for the LFEPA has been involved in inspecting the home and the home meets all fire safety requirements. The last fire officer inspection took place in November 2007 resulting in the home being awarded a gold star status. At the last inspection a requirement was made to carry out risk assessments for all residents assessed as having mobility support needs in relation to the use of stairs and steps in the home. This has now been met. (Refer to Standard 7). All of the home’s fire, electrical, gas and lifting equipment have been maintained and the home has on file appropriate documentation on file to show this. There have been no reports of accidents in the home under RIDDOR. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement The registered provider and manager must show evidence of medication which has been returned to the pharmacist and that it has been received by them, in order to ensure that medication is fully accounted for. In consultation with residents and their representatives the registered provider and manager must ensure that the personal care plans, for residents who have high mobility support needs, and for those residents who cannot communicate their needs verbally, include guidance for staff in how to ensure that they are enabled to do as much as they can for themselves, so that they can maintain their independence and fully protect their dignity. Timescale for action 31/10/08 2 OP10 12 (2)(3) & (4)(a) 31/03/09 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations As part of the care planning process the registered manager should include a pen picture of what dementia means to each individual resident in order that staff may be better able to judge when to offer activities. The registered manager should ensure that the risk assessments for residents use of stairs include a conclusion section, stating whether the risk is now acceptable for these residents, and whether it is required that they reside on the ground floor in order to maintain their safety. The registered manager should ensure that residents exercise opportunities be spread out more over the week, and that they be encouraged by staff to reschedule activities when opportunities for these are missed. The registered manager should ensure that the need for review of one residents medication be brought to the attention of their GP as discussed in this report Standard 9. The registered manager and provider should consult with commissioning agents, service users/families and their own staff to gain a fuller understanding on their views on whether residents being admitted to hospital should be accompanied by staff who know them, and act on findings as part of the homes quality assurance consultation system. The registered provider and manager should examine options as to how the bank of staff available for use in emergencies can be increased beyond the limitations of that currently provided as discussed in this report Standard 27 The registered provider and manager should ensure that the home continue to closely monitor the staff time available for interaction with residents on the first floor to ensure their social needs continue to be met. 2 OP7 3 OP7 4 OP9 5 OP27 6 OP27 7 OP27 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V361273.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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