Care Home: Kirkland House

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What the care home does well Assessments are carried out before a person moves into the home, so they can be sure that the person`s care needs can be met. Staff offer discreet and kind support, which we observed during the visit. People confirm that they feel well treated and are encouraged to exercise choice in their daily lives. Visitors are always welcome at the home and people are encouraged and supported to maintain and develop relationship with other people in the home, their families and friends and to maintain links with the local community. The home is well managed and organised, with the care, contentment and safety of people being central to the way the home is run. What has improved since the last inspection? The manager said they try to make sure there is enough staff on each shift to meet the needs of people. Since the last key inspection the carpet in the large communal sitting area and hallway on the ground floor have been replaced. All identified risk has a plan of the action to be taken to manage or minimise the risk. What the care home could do better: The staffing levels must be reviewed and, where necessary increased, to make sure that there are sufficient staff on duty at all times to meet people`s needs and keep them safe. CARE HOMES FOR OLDER PEOPLE Kirkland House Queensway Yeadon Leeds LS19 7RD Lead Inspector Valerie Francis Key Unannounced Inspection 20th January 2009 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 Kirkland House DS0000033261.V373863.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. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kirkland House Address Queensway Yeadon Leeds LS19 7RD 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) 01943 876392 01943 876392 Leeds City Council Department of Social Services David John Stanley Hoare Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2007 Brief Description of the Service: Kirkland House is a large building situated in a residential area of Guiseley. The location offers a good bus service to Yeadon and access to the Guiseley shopping Centre. The building is a large detached purpose built care home for older people, which is owned and managed by Leeds City Council Social services. Kirkland House accommodates 31 older people on two floors. There are 31 single bedrooms. The first floor can be reached via a passenger lift. Toilets are strategically placed throughout the building, giving easy access to people. There are four baths and a level access shower, which provides choice and support at the time of bathing. There is satisfactory parking at the front of the home. The provider completed and returned pre inspection information including the current charges, which range from £77.95 a week for local authority funded people to £497.30 for privately funded residents. Additional charges are made for chiropody, hairdressing, daily papers, toiletries, some activities and transport. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home by one inspector, which lasted about seven hours. This report is based on information gathered in a number of ways. A review of the information we have received about the home since its last inspection. Information sent to us by the registered provider in a document called the Annual Quality Assurance Assessment (AQAA) self assessment information, which tells us what the home does well, what improvements they have made and what they could do better. Comments made from people, visitors and staff during the inspection. This visit included a tour of the premises and talking to people who live at the home, staff and management. We also looked at menus and people’s care plans and watched staff looking after people. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: Assessments are carried out before a person moves into the home, so they can be sure that the person’s care needs can be met. Staff offer discreet and kind support, which we observed during the visit. People confirm that they feel well treated and are encouraged to exercise choice in their daily lives. Visitors are always welcome at the home and people are encouraged and supported to maintain and develop relationship with other people in the home, their families and friends and to maintain links with the local community. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 6 The home is well managed and organised, with the care, contentment and safety of people being central to the way the home is run. What has improved since the last inspection? 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. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 7 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 Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 8 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There is information about the home to help people make a decision about using it. People who want to use the home’s service have an assessment before they can move in, so that a decision is made if their needs can be met by the home. EVIDENCE: People who want to use the service and their representatives are given a copy of the home’s Statement of Purpose that gives them information about the home and the service it provides. When people move in they are also given a copy of the home’s information pack, which provides them with detailed information such as the visitors policy, licence agreement and the complaint procedure. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 9 The manager and the care officer said that they were in the process of reviewing both the statement of purpose and the service user guide which is given to people when they move in as part of the home information pack. We looked at the care file for the last person who moved into the home. Although a preliminary assessment had been done by the home, the information was not enough about that person’s care and support needs. We also saw that a copy of the assessment report from the placement agency was sent to the home. However, the assessment had been carried out nine months before to the person been assessed by the home. We were able to speak to the person’s key worker who said she was in the process of getting more information about the person in order to create a lifestyle plan. She had contacted health care professionals who had been involved in the person’s care. The person and family members were also contacted for further information. The home told us “ on admission we offer each resident a resident guide with up to date information of the facilities”. In the AQAA we were told, “we ensure that prior to admission of people a full core assessment or easy care plan is received from the social work team. Introductory visits are held prior to admission and a preliminary assessment is made of that resident’s need, the key worker to the clients when possible will greet the resident and discuss any issues or concerns. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 10 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 &10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s care and support needs are met by staff who are suitably trained. Medication systems within the home safeguard the health and welfare of people. EVIDENCE: Three care files were looked at as part of the case tracking process, all three had care plans (Life Style Plans) that had been devised by the organisation. One of the care files seen was for the person who had recently moved into the home, no care plan was in place. The key worker was working with the lady and her family to put together her Life Style Plan. We saw and heard good discussion with the lady about her likes and dislikes which included the social aspect of her care for example reading and the type of books she liked. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 11 The other two people have lived at the home for some time, although we found and we were told by people, staff and visiting relatives that they had been involved in the review of their care plan, changes identified at the review were not reflected in their care plan. For example one person’s review indicated that they had weight loss, but there was no plan in place to show how this would be managed. There were risk assessments for mobility, falls, moving and handling and the use of walking aids. Any areas identified as a risk, a plan of action to minimise and manage the risk had been developed to safeguard the person and staff. All staff have had accredited training on safe handling of medication. We saw that the home has good systems in place for safe handling of medication to make sure people are safe. However, we were told that there is arrangement that the pharmacy will collect repeat prescriptions from the GP surgery. We recommend that prescriptions should go back to the home to be checked and copies kept of the prescription as recommend by the Royal Pharmaceutical society guidelines for residential homes. We found that the record of administration had a log of signatures for all staff that administer medication. The manager or care officer checks the medication administration book regularly for omissions of signatures for medication given to make sure people’s medications are given. This is good practice. People spoken to during the inspection said they are treated with respect and their privacy and dignity is protected at all times. Although some people and their relatives could not remember the name of their key worker, it was obvious that people had a designated person who looked after their personal needs. One person said that during the time she did not have a key worker she found it difficult to ask other staff for help, although she knew that all staff would support her with anything she needed. One person said” due to the staff situation those people who can look after themselves they get less attention and nobody seems to have time to talk to them. In the AQAA we are told that “we listen to our residents when completing their care plan and ensure their views and beliefs are incorporated. We encourage residents to be actively involved in formulating their plan of care and how their needs will be met. We ensure this is done in a dignified manner and respecting their privacy and confidentiality”. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 12 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People have the opportunity to take part in social and recreational activities and are encouraged and supported to pass time how they wish. A choice of food is provided on the menu board, meals are nutritious and appetising. EVIDENCE: The home arranges seasonal and celebration activities and engages people with outside entertainers brought in by the home. Staff told us, “Social recreational activities are mostly done during the evening”. We saw two people’s care files with life history information that gave staff some background information about the persons’ life before they moved into the home. Staff told us “in some cases relatives write the life history for their relatives”. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 13 The home has several communal rooms. However, the communal sitting areas on the ground floor are mainly used, people indicated that this gives them the opportunity to see what is going on around them and are able speak to each other and staff. Visitors are welcomed at any time and those spoken to during the visit said “we are always made to feel welcome and placed at ease by the staff”. From comments we received it was evident that people believe they are shown respect and treated properly. People told us that they were well looked after, staff are very good and despite there being a shortage of staff they still have the opportunity to take part in recreational activities in the evening such as Bingo and word search and sometimes when the weather is good they go out for pub lunches. People and their relatives praise the care and management staff for the way in which they provide care. We were told by people that, “staff had gone that extra mile to give them a good Christmas and New Year”. One person told us “due to the lack of staff, some staff are not interested in doing activities”. In the AQAA we are told that residents plan their summer outings at the beginning of the year, this enables the staff to arrange the requested outings, transport and finance. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 14 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&18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People know how to complain and are confident that their complaints will be listened to. People are safeguarded against risk of any abuse. EVIDENCE: People know how to complain and feel confident that if they had any concerns or complaints they will be listened to and taken seriously. The home has a complaint procedure. Since the last key inspection a complaint has been logged with us and we are awaiting the result of the investigation. On the day of the inspection we were told about a complaint that was made by one of the people in the home, the manager and care officer investigated this. We have not received any allegations of any safeguarding matters. Staff told us that they were having up to date training on safeguarding which was planned. The home has a policy on the protection of vulnerable adults and discussion with staff confirmed that they understand the correct procedure. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 15 The home told us in the AQAA “we encourage an open door policy, we advise residents and their families to voice any issues or concerns at any time. We give feed back on our findings and deal with all matters seriously”. A copy of the complaint procedure is given to people on admission to the home and notices are in sight throughout the home. All care staff have received training by the Adult Abuse co-ordinator. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 16 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 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is comfortable, clean well equipped and suited for the needs of people living in the home. EVIDENCE: The building is well maintained and no health and safety issues were noted. There is a ramped area to all entrances to the home. People who needed assistance can use all bathrooms; one bedroom and a bathroom have a ceiling tracking hoist. All bedrooms seen were personalised to a high standard, it was evident that people had taken the opportunity to bring with them furniture and other items to personalise their room. Some people had telephones installed in their rooms so that they could keep in contact with family and friends. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 17 The building throughout was seen to be clean to a high standard and no bad smell was detected. There is a range of sitting rooms available to people with two large sitting areas on the ground floor, which people mainly use. The home has recently had a conservatory built for additional sitting space on the ground floor. The manager said they were waiting for the emergency call system to be installed. There are three other sitting rooms on the first floor, which we saw, was used by small groups of people to have their meals and as a meeting place with friends. All communal sitting areas are furnished with easy chairs and tables and the atmosphere in the home was happy and homely. No bedrooms have en-suite toilets. However, there are toilet and bathing facilities situated strategically around the home on each floor, to allow people easy access. There is a loop system in place in the main lounge on the ground floor, to help those people wearing a hearing aid with clearer surround sound. There are hand washing and drying facilities in place in all bathrooms and toilet. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 18 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 & 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are met by well trained staff. However, staffing levels need reviewing to make sure that people are safe. EVIDENCE: Staffing levels during the day of the visit appeared to be enough to meet the needs of people living at the home. Although some people and staff did comment to us about the home being short staffed. Since the last key inspection West Yorkshire Fire Service has visited the home and has recommended that the staffing levels at night should be increased, because of the layout of the building and fire safety. The staffing levels must be reviewed, and increased if necessary, to make sure that there are sufficient staff on duty at all times to meet people’s needs and keep them safe. At the time of this visit there were some vacancies in the care and management team. The manager told us that they were waiting the (CRB) Criminal Records Bureau check and references for one person. All other posts had or were in the process of being advertised. We saw three staff files, which are held in the home, there are copies of application forms, references and CRB disclosures which are obtained for all staff in advance of employment. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 19 Induction training is arranged for all new staff and on going training for all staff. There is opportunity for all staff to have training, we saw a copy of the Social Service Department training courses for residential homes, such as dementia care skill, and activity for people with dementia. One member of staff told us that they were doing a Palliative care course. The home has over fifty percent of care staff with (NVQ) National Vocational Qualification level 2. Plans are in place for staff to have supervision every 8 to 10 weeks carried out by one of the management team who is designated to be their supervisor. One staff told us, “At this moment in time my supervising officer is taking the work load of three staff as there is a shortage of staff in the office, he knows that my supervision is due and therefore every shift he asks me if I have any concerns or problem. I know that I can speak to him without waiting for supervision”. People told us, “There is a shortage of staff, but staff still give us good care and support, nothing is too hard for them to do for us, they always try to make time for us”. The home told us in the AQAA, “We have committed and motivated staff with experience and knowledge. Staff are aware of individual needs and provide a high standard of care. We follow the department recruitment and selection process”. Staff said, “all staff are working very hard to help the smooth running of the home and are helping to cover many shifts, as our priority is the wellbeing of our residents”. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 20 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 & 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is properly managed and maintained in the best interest of people living in the home. EVIDENCE: Since the last key inspection there has been a change in the registered manager. The new manager has been in post from since April 2008. There have also been some changes in the management team and there is a vacancy of a care officer. The manager is suitably qualified with experience of working with older people and the management of staff. The records of money kept for people, a copy of all receipts and invoices is documented. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 21 The home has a range of ways of getting the views of people on the service at the home, such as house meetings and meetings with people and their family. The manager told us that a plan is in place to send out Quality Audit questionnaires to people and others twice a year, to further get people’s views on the home more regularly. The outcome of the quality audits is discussed with people and their relatives in their meetings. People indicated to us that although there have been some changes in the management team, the home is still run the same way and they can see the new manager at any time. In their AQAA the home said “our management team have relevant experience and qualifications and are dedicated to the care of the residents and the smooth running of the home”. “We actively encourage and develop ourselves and the staff team, to update and gain further knowledge that is relevant to our position to promote a better understanding to fulfil our responsibility”. Records indicate that fire safety equipment is routinely checked and tested at the required frequencies. During the visit we saw records that confirm this. A member of staff told us that I find it very easy to speak to management if any concerns arise, they are very approachable and all correct procedures are in place. Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 22 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 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 X X 3 Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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 OP27 Regulation 18 Requirement Timescale for action 15/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kirkland House DS0000033261.V373863.R01.S.doc Version 5.2 Page 24 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 61 61 61 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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