Care Home: Kirklands

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What the care home does well People told us that they received enough information about the home to help them make their decision to move there. As part of the admission assessment people are able to visit the home and there may be an opportunity for a short stay. This helps people to get a good picture of what life at Kirklands might be like. The people we spoke to told us that the staff are `very kind and friendly`. They told us that they are `treated well` and that visitors are made `very welcome` in the home. One person said; `my relative recognises that she needs care and is very happy and appreciative of all carers.` Another person said; `visitors are made to feel very welcome and staff make an effort to get to know them.` Some of the other comments we received from people who use this service included; `The staff treat everyone as an individual and remember their likes and dislikes.` `The service provides a good standard of care and takes into account everyones individual needs and gives the right care and support on a one to one basis.` The service also provides a very good catering service. The chef and her staff are very knowledgeable about each individual`s dietary requirements and preferences. The menu`s offer extensive choices and there is a separate menu with vegetarian options. People told us about the meals and food at the home, many of them said they had `put on weight` since moving into Kirklands. People who were able to complete surveys told us that they have access to a variety of interesting social activities that they may choose to participate in if they wish. People told us that they can spend time in their own room if they wish, reading, listening to their radio or watching their own television. Some people told us that they like to attend the multi-faith religious services that are regularly held at the home. What has improved since the last inspection? We looked at a sample of people`s care plans whilst we were at the home. The manager has reviewed and updated these to include more detailed information about individual care and support needs. The care plans include night care plans to help ensure people get the support they need during the night. The home has struggled to access dental services for some of the people that live at Kirklands, but the manager has now secured access to emergency dental services. The manager takes complaints very seriously and has started to introduce a system to identify potential problems at an early stage. This will help to ensure issues are dealt with quickly and before they escalate into bigger complaints. Complaints are monitored and audited to help make general improvements to the home and the service. One of the bathrooms has been refurbished to provide a pleasant and relaxing environment for residents. There are plans for further refurbishments of other bathrooms, shower rooms and the upstairs activities room. At our last inspection of the service, one of the things we asked the manager to do was to ensure staff received supervision and support from senior staff. We found that this request has been implemented. Staff supervision helps to ensure staff are working in line with the procedures of the service and meeting the needs of the people that live at Kirklands. What the care home could do better: Although some improvements have been made to the care plans at the home, further improvements could be implemented. The manager told us that further improvements would help to make them `truly person centred.` The care plans for people who may have dementia illnesses or display aggression, particularly need improvement. This will help ensure people`s care and support needs are clearly detailed and staff understand how to support them appropriately and safely. The staffing levels at the home would benefit from review to help ensure there are a sufficient number of staff on duty, at all times in order to meet the care and support needs of people using this service. There is a significant number of residents with high care and support needs, many of which need two carers to support them to meet these needs. We received comments from various sources about the staffing situation at the home. Some of the residents that live at Kirklands told us that there are `usually` enough staff to meet their needs and support them with their care. The staff that returned surveys to us said that there are `usually` or `sometimes` enough staff on duty. One member of staff said; `there are not enough staff to give the very physically and mentally frail residents the time they need to receive the best care.` A relative told us; `Kirklands is giving our relative a lot of care and attention, she is quite happy there. However, I sometimes notice the staff are run off their feet, perhaps more staff would be helpful.` and another said; `I feel that since my relative has gone there the amount of staff is not enough to meet the patients needs.` Some attention needs to be given to the training programme at the home to help ensure staff understand and know how to support residents appropriately. Staff have received training but some of this training has not been undertaken for some time and staff would benefit from some refresher training. We found that staff are not trained to help them work with people who may demonstrate aggressive or challenging behaviour. One member of staff told us; `Some of the residents are extremely demanding, the staff need more training on challenging behaviour. Staff all react differently therefore there is no consistency and there is no improvement in the situation.` Another member of staff told us; `Training is adequate but I would welcome more than just compulsory courses. We don`t get training to help understand and meet the needs of people. The service needs to look at the way in which some medications are managed and to the way in which medication records are maintained. We found some discrepancies in the medication administration records and where creams or ointments are administered, this is rarely recorded. People must receive their medicines as the doctor intended and records help to provide an audit trail to ensure this is the case. Some areas of the home were not particularly clean. We discussed this with the manager and showed her some of our concerns. The manager should review the housekeeping arrangements to ensure that all areas of the home are clean and fresh. As a result of this visit we have made four statutory requirements and eight good practice recommendations. Key inspection report Care homes for older people Name: Address: Kirklands Sullart Street Cockermouth Cumbria CA13 0EE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Jinks     Date: 1 7 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Kirklands Sullart Street Cockermouth Cumbria CA13 0EE 01900822364 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.anchor.org.uk Anchor Trust care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The home is registered for a maximum of 40 service users to include: - up to 29 service users in the category of DE(E) (Dementia over 65 years of age) - up to 7 service users in the category of OP (Older people not falling within any other category The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Two named service users in the category of MD(E) (Mental disorder, excluding learning disability or dementia over 65 years of age) may be accommodated within the overall number of registered places Two service users in the category of LD(E) (Learning disability over 65 years of age) may be accommodatd within the overall number of registered place Date of last inspection Care Homes for Older People 0 4 0 6 2 0 0 9 0 0 0 0 Over 65 29 2 2 7 Page 4 of 34 Brief description of the care home Kirklands is a modern, purpose built home situated in a residential area of Cockermouth. It is within walking distance of all the local amenities in the town centre. The home is operated by the Anchor Trust and managed by Mrs. Maureen MacColl. The home provides accommodation and care for up to forty older people, thirty of who may have dementia. The accommodation is on two floors, and is divided into four living units. Each unit has a lounge/dining room, with bedrooms, toilets and bathrooms close by. The home has a passenger lift and a range of other equipment to assist people in their day-to day-lives. There are garden areas that are provided with safe and secure seating areas. There is a car park to the front of the home. Information about the home, including the weekly fees are available from the manager at the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service takes into account all of the information we have received since the last inspection. We sent surveys to some of the people that live and work at this home in order to obtain their views about Kirklands. We also received some comments from relatives of people that live there. The inspection included a visit to the home. I was accompanied by another inspector, Mrs Margaret Drury and we spent six hours at the home. During our visit we looked at a variety of the records that the home is required to maintain. We looked around the home to assess the general environment and living accommodation provided to people that use this service. We spoke to some of the people that live and work at Kirklands, including the manager. The manager completed an annual quality assurance assessment (AQAA) and returned this to us. The information recorded in the AQAA provides us with information about Care Homes for Older People Page 6 of 34 the service and helps us to check the information we gather during the visit to the home. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? We looked at a sample of peoples care plans whilst we were at the home. The manager has reviewed and updated these to include more detailed information about individual care and support needs. The care plans include night care plans to help ensure people get the support they need during the night. The home has struggled to access dental services for some of the people that live at Kirklands, but the manager has now secured access to emergency dental services. The manager takes complaints very seriously and has started to introduce a system to identify potential problems at an early stage. This will help to ensure issues are dealt with quickly and before they escalate into bigger complaints. Complaints are monitored and audited to help make general improvements to the home and the service. One of the bathrooms has been refurbished to provide a pleasant and relaxing environment for residents. There are plans for further refurbishments of other bathrooms, shower rooms and the upstairs activities room. At our last inspection of the service, one of the things we asked the manager to do was to ensure staff received supervision and support from senior staff. We found that this request has been implemented. Staff supervision helps to ensure staff are working in Care Homes for Older People Page 8 of 34 line with the procedures of the service and meeting the needs of the people that live at Kirklands. What they could do better: Although some improvements have been made to the care plans at the home, further improvements could be implemented. The manager told us that further improvements would help to make them truly person centred. The care plans for people who may have dementia illnesses or display aggression, particularly need improvement. This will help ensure peoples care and support needs are clearly detailed and staff understand how to support them appropriately and safely. The staffing levels at the home would benefit from review to help ensure there are a sufficient number of staff on duty, at all times in order to meet the care and support needs of people using this service. There is a significant number of residents with high care and support needs, many of which need two carers to support them to meet these needs. We received comments from various sources about the staffing situation at the home. Some of the residents that live at Kirklands told us that there are usually enough staff to meet their needs and support them with their care. The staff that returned surveys to us said that there are usually or sometimes enough staff on duty. One member of staff said; there are not enough staff to give the very physically and mentally frail residents the time they need to receive the best care. A relative told us; Kirklands is giving our relative a lot of care and attention, she is quite happy there. However, I sometimes notice the staff are run off their feet, perhaps more staff would be helpful. and another said; I feel that since my relative has gone there the amount of staff is not enough to meet the patients needs. Some attention needs to be given to the training programme at the home to help ensure staff understand and know how to support residents appropriately. Staff have received training but some of this training has not been undertaken for some time and staff would benefit from some refresher training. We found that staff are not trained to help them work with people who may demonstrate aggressive or challenging behaviour. One member of staff told us; Some of the residents are extremely demanding, the staff need more training on challenging behaviour. Staff all react differently therefore there is no consistency and there is no improvement in the situation. Another member of staff told us; Training is adequate but I would welcome more than just compulsory courses. We dont get training to help understand and meet the needs of people. The service needs to look at the way in which some medications are managed and to the way in which medication records are maintained. We found some discrepancies in the medication administration records and where creams or ointments are administered, this is rarely recorded. People must receive their medicines as the doctor intended and records help to provide an audit trail to ensure this is the case. Some areas of the home were not particularly clean. We discussed this with the manager and showed her some of our concerns. The manager should review the housekeeping arrangements to ensure that all areas of the home are clean and fresh. Care Homes for Older People Page 9 of 34 As a result of this visit we have made four statutory requirements and eight good practice recommendations. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are provided with sufficient information about the home. This helps them to make their decision to move into Kirklands and to decide whether the home will be able to meet their needs and expectations. Evidence: The home has produced information about the facilities and services it provides - the Statement of Purpose. This information is available in different formats to help make it accessible to more people. This document provides prospective residents with information about the admission process including the arrangements for assessing health and social care needs, initial care planning and the arrangements in place for people who may need to be admitted to the home in an emergency. People are encouraged to visit the home to help them make their decisions to move Care Homes for Older People Page 12 of 34 Evidence: there. The manager tells us that it may be possible for people to try a short stay prior to moving in but this is dependent on vacancies. Initially people move into the home for a trial period of four to six weeks. This helps to ensure that the home is suitable and is able to meet the needs and expectations of new residents. Most of the people we spoke to or who returned surveys to us, told us that they received enough information about the home to help them make their decisions to move there. One person told us; My relative has only been in Kirklands a few months. They are beginning to settle but would obviously prefer to be at home. My relative speaks highly of the care and staff who she considers to be considerate and very kind. The people that come to live at Kirklands have usually received a care needs assessment from their social worker. The manager told us that she also carries out pre-admission assessments to help ensure that the home is the most suitable place for the individual to move to. Information about the home, the services and facilities available is kept in each persons room for their reference. There are some aspects of this information that need to be updated to ensure it reflects the current situation. The manager told us that she is aware of these shortfalls and that she intends to update the information very soon. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service have a plan of their care and support needs and of how those needs will be met. This helps to ensure that people recieve the support they need, when they need it. Evidence: During our visit to the home, we looked at a sample of care records and care plans for five of the people that live there. The manager told us that care plans are developed with each resident and are based on the information detailed in their care needs assessment. We noted that there had been some improvements to the care planning process since our last visit to Kirklands. The manager told us that further improvements could be made to help ensure that the plans are truly person centred. We found that some of the information recorded in the care plans of people who have dementia illness was quite limited, particularly where people may sometimes demonstrate aggressive or challenging behaviour. A member of staff told us; Communication is still a problem and staff often find out Care Homes for Older People Page 14 of 34 Evidence: information by accident. There are contradictions on how to do things leading to staff becoming confused and disillusioned with their job. This may then affect the care they provide. Some of the residents are extremely demanding and staff need more training on challenging behaviour. Staff all react differently therefore there is no consistency and there is no improvement in the situation. We found that care plans generally contain more detailed information regarding the help people need with their daily lives. The information recognises and acknowledges that people need to maintain as much independence as possible. Some of the people who live at Kirklands told us that they are able to make choices about their daily lives and are encouraged to keep themselves as active as possible. They told us that they were well looked after and that their preferences were respected. Care plans contain information about the personal support people need and include elements of risk assessment, nutritional assessments and plans for the level of care people require during the night. This information helps to ensure that staff support people in the most appropriate way to meet their needs at all times. Furthermore, care plans are reviewed and updated at least monthly, to make sure they accurately reflect the current requirements of people using this service. We saw that care plans recorded the religious beliefs of people using this service. We also found that end of life wishes had been discussed with the resident and/or their relatives with preferences clearly recorded. People did tell us that they have access to healthcare professionals such as GPs , community nurses, chiropodists and are supported to attend hospital appointments. The manager told us that people living at Kirklands do have access to emergency dental treatment but that this is an area where difficulties have been experienced in securing general dental care for residents and the manager continues to try to secure this type of care. We saw that staff at the home do not consistently complete the records relating to visits by healthcare professionals. This is an area that could be improved to help ensure people receive healthcare treatment when they need it and to help ensure that staff supporting them are aware of any changes to their care needs and requirements. People taking part in the inspection of this service told us that staff always treat them with respect and dignity. We observed some of the staff working in the home. We saw that they knocked on doors before entering rooms, they addressed residents by their preferred names and were patient and sensitive to their support needs. Care Homes for Older People Page 15 of 34 Evidence: Some of the comments we received from people who use this service included; The staff treat everyone as an individual and remember their likes and dislikes and another person said; The service provides a good standard of care and takes into account everyones individual needs and gives the right care and support on a one to one basis. One relative told us; My aunt recognises that she needs care and is very happy and appreciative of all carers. Our pharmacist inspector made a random visit to Kirklands in June 2009 to check on the ways in which medications were managed. She found that generally medicines were managed safely. There were some gaps in the recording processes and she made a good practice recommendation for the manager to consider implementing. During our visit to the home we briefly looked at the ways in which medication is managed. The home has policies and procedures in respect of the administration of medication, staff are provided with training and medication is mostly stored securely. These things should help to ensure that medication is managed safely. We sampled some of the medication administration record charts. Generally, they had been completed accurately but there was one error where administered medication had been recorded in the wrong section of the record. This gave the appearance that one medicine was given too frequently, whilst the other looked like it had not been given at all. We told the manager of this mistake as it needs to be addressed urgently. Where people are prescribed ointments and creams, we saw that these are kept in individuals rooms so that staff can administer them during personal care procedures. However, this type of medication is not kept securely and we saw creams and ointments left out in service users rooms, some of which were out of date. Additionally, although there are care plans devised for the use of creams and ointments there are gaps in the information. Records showing when and where ointments and creams should be applied or administered are not maintained with any consistency nor do they always provide clear information. Administration records have not been kept accurately. This means that people using this type of medicine may not always receive it as the doctor intended. The manager told us that there are robust medication policies and procedures in place and that they are regularly audited to ensure the quality is maintained. She also told us that all rooms do have a lockable container for the storage of medication. We discussed our findings with her. She was unaware of these shortfalls. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are aware of the need to support residents with leisure and social activities. Some of the people using this service are provided with a wide variety of stimulating and interesting activities. This helps to sustain their general well-being. Evidence: The manager told us that activities are provided in a flexible way and in line with the wishes of those residents involved at the time. There are two activity organisers at the home who try to offer a wide variety of activities to choose from. Some of the people we spoke to or who returned surveys to us told us of some of the activities on offer at the home. They told us that they are able to choose whether to join in or not. Some of the people we spoke to prefer their own company and like to sit in their room with their own television, radio, newspapers or books. One person has arranged to have their computer installed, complete with internet access. We looked at some of the records that have been kept about the activities in the home. The records describe various events and photographs have been taken for people to look back on. Some of the activities available include; outside entertainers, trips out, parties and a visit by the Owl sanctuary. Care Homes for Older People Page 17 of 34 Evidence: The manager told us that residents meetings take place. Minutes are kept of these meetings. Residents have been consulted about the activities on offer and these have been reviewed. For example, the manager told us that residents selected the Christmas entertainment and chose the week before Christmas for the relatives and friends party. Some of the people that live at Kirklands like to attend the multi-faith service that is held in the home by a local vicar. One of the people we spoke to during our visit to the home told us about their experiences of life at Kirklands. They said the food is excellent and that they have put on weight since moving in. They said that they like to be independent and are able to go out of the home sometimes. They like to attend the communion service in the home but choose not to join in the other activities. Another person told us the they had; no complaints, the staff are very good and the food is excellent. I like to sit and knit or reading my own room. I prefer a shower rather than the bath and I can have a shower when I like. We sat outside one of the lounge/diner areas on the ground floor looking at care records for some of time in the home. We noted that there was very little interaction between staff and the people who live in this part of the home. One person was sat at the table for the whole time, sometimes sleeping sometimes vocalising. Another person was in the same room calling out or shouting from time to time. The information produced by the home says that Kirklands specialises in providing care for people with mental frailty. During our time in the home we did not see any evidence that this group of people are provided with suitable or stimulating activities to help promote their well-being. Some of the comments we received from residents, staff and relatives compare with our findings. One person said; my aunt recognises that she needs care and is very happy and appreciative of all carers. Not only care and kindness but lots of activities and visits (by coach) to local areas and also the visits made to the home by musicians and the slide shows of Cockermouth past and present. Another person said; visitors are made to feel very welcome and staff make an effort to get to know them. Activities are always advertised in the home and in a quarterly news letter. People also said; I feel that since mum has gone there the amount of staff is not enough to meet the patients needs. Another said; It could have more staff to spend time with the residents and also to take them out into the fresh air more. Care Homes for Older People Page 18 of 34 Evidence: Some of the staff told us; Id like to see more activities staff so more time can be spent with individuals 1:1. Another said; Give the staff more time with the residents, whilst a third member of staff told us that there are not enough staff to give the very physically and mentally frail residents the time they need to receive the best care. We observed the service of the lunch time meal. This was a very positive experience for the people that use this service. Food is presented in an appetising and tempting manner. People are shown plated examples of the meal options to help them make their choices. Pureed food is done separately and served in an appealing manner. Staff eat their lunch with the residents. They sit at the same tables and help and encourage residents with their meals where needed. They chatted to residents and encouraged them to eat and drink. Time was taken and there was no rushing, it was a very pleasant and sociable event. We spoke to the chef at the home. She is very knowledgeable about each resident and their individual dietary needs, likes and dislikes. The chef is fully aware of people with special dietary needs for example diabetic or vegetarian and these people are well catered for. The chef told us of the training she has received and also that the second chef at the home had completed the in house catering training course. We saw the menus at the home and noted that people are provided with an extensive variety of foods and meals, including seasonal or topical examples such as pancakes on Shrove Tuesday. From the people we spoke to and the care records we looked at the catering service is something that the home excels at. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are confident that any concerns raised with the manager or staff will be listened to and dealt with to their satisfaction. Evidence: The home has policies and procedures in place to help people make comments or complaints about the service. This information is included in the service user guide and is also displayed in the home. The people who returned surveys to us indicate that they know about these processes and that they know who to speak to if they are not happy about something. Some of the relatives told us that if a concern is raised, it is usually dealt with appropriately. People told us that staff always listen and act on what is said to them. One resident told us; If a concern has been made known to a care worker or senior they always give some feed back at a later date on progress. We looked at the complaints that the home had recieved since our last visit. Details of any complaints made are kept in a record book, showing details of the complaint and the person raising the issue. Records are kept of the investigation, what the outcome was and of any action taken. The manager tells us that over the last twelve months the service have tried to capture and record the little niggles that people do not think are important. She has Care Homes for Older People Page 20 of 34 Evidence: done this to try to reduce the effect that small things have on the quality of life of the individual concerned. The manager plans to make further improvements to the way complaints are handled by providing further training for staff around the issues of complaints. The home also has policies and procedures in place to help ensure people are protected from the risks of harm or abuse (safeguarding). The issues and processes about safeguarding are included in the staff induction training programme. Further training takes place and the manager tells us that half of the staff at the home have attended a full days training event on this subject. Staff training in safeguarding (abuse) helps to ensure that staff awareness and knowledge are refreshed or kept up to date, helping to ensure people using this service are safe and protected. The manager has told us that further training is needed to make improvements and safeguarding training, including reference to the Mental Capacity Act, is to be undertaken by staff in April 2010. Complaints and safeguarding incidents are recorded and monitored across the whole Anchor organisation. This helps to ensure they are dealt with consistently and also helps to provide learning points for services, enabling further improvements. Another area that helps ensure people using this service are protected from harm are the staff recruitment processes. We found that the home follows strict guideline to help ensure people are supported by a suitable workforce. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides a warm and comfortable environment for the people that live there. There are some areas where improved cleaning routines would help reduce the risk of infection. Evidence: Kirklands provides accommodation and care for 40 people. The home is purpose built and all of the rooms are intended for single occupancy. Bedrooms have en-suite toilet and wash basins. There is an on-going maintenance plan in place at the home and the manager has told us where improvements to the environment have been made and about the plans for further refurbishments and upgrades. The manager is in the process of employing a gardener to help ensure the gardens and grounds at the home are maintained safely and in good condition. The home has a maintenance man who keeps the interior of the home in good repair. The manager has told us that all the services, appliances and equipment in place at the home are serviced and checked frequently. People living at Kirklands are able to personalise their own bedrooms as they wish, Care Homes for Older People Page 22 of 34 Evidence: although any electrical items brought into the home are subject to prior safety testing. We looked at some of the residents bedrooms. They were in the main clean and tidy although two of the rooms we looked at did have strong, unpleasant odours. We reported these to the manager for further cleaning and attention. She was unaware of these matters. In addition to residents personal, private rooms, there are several communal areas including lounges and dining rooms. The home has recently refurbished a small room in order to provide a more private area where residents may wish to meet their families or conduct their private business. The colour schemes throughout the home are chosen in line with the needs of people who may have dementia and most of the doors to the communal bathrooms and toilets are painted in a different colour to the bedrooms. The corridors on each unit are painted with murals of local beauty spots and decorated with old photographs and pictures. The bath and shower rooms at the home are well equipped to help people access facilities as independently as possible. There is an issue with a musty odour in most of the bathroom areas. The manager told us that she was aware of this problem. Most of the bathrooms are in need of some renovation work particularly the tiling and grouting, which is dirty, mouldy or badly cracked and could potentially cause a risk to the control of infection. There are communal dining areas and lounges on both floors of the home. These are adjoined by small kitchenettes where breakfast, snacks and drinks are prepared by staff for residents. We found the kitchenettes to be in a poor condition. The sinks together with the grouting and tiling around sinks were dirty and badly stained. The floors in these areas were also dirty, particularly right up against the kitchen units. The worktops were not clean and some of them were breaking up underneath and at the edges where water had ingressed. The manager told us and training records confirmed that all staff at the home have had training in infection control procedures. We spoke to one of the housekeepers during our visit. She told us that she is provided with various health and safety training and is included in staff meetings. This helps to make sure that she is working safely and is also able to contribute her views to the running of the home. She told us that she is always provided with enough suitable cleaning materials and equipment, including gloves, aprons and appropriate waste disposal bags. Care Homes for Older People Page 23 of 34 Evidence: People who took part in the assessment of this service told us that the home is usually clean and fresh. One relative said, the residents are comfortable and their rooms are nice with plenty of space. A member of staff thought that the home could do better by paying more attention to housekeeping and cleanliness. Comments were also received about the heat at the home. One person said, my relative finds that it is too warm mainly in the dining rooms. We the relatives also find it too warm and stuffy it seems that the heat cannot be regulated either. We did find that some areas of the home were rather warm and stuffy. However, it was a cold day outside and some of the residents did not want draughts from open windows. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are not always supported by a sufficient number of staff, nor are they always supported by staff who have appropriate skills and experience to understand and meet their needs. This means that people may not always get the care and support they need, when they need it. Evidence: The home has recently reduced their staffing levels and at the end of last year some staff were made redundant. The manager has not recruited any new care staff since our last visit to the home. The are indications that there may not always be a sufficient number of staff on duty to meet the care and support needs of people using this service. Some of the residents that live at Kirklands told us that there are usually enough staff to meet their needs and support them with their care. The staff that returned surveys to us said that there are usually or sometimes enough staff on duty. Some of the comments we received from relatives and staff included the following: There are not enough staff to give the very physically and mentally frail residents the time they need to receive the best care. (Staff member) Kirklands is giving our relative a lot of care and attention, she is quite happy there. However, I sometimes Care Homes for Older People Page 25 of 34 Evidence: notice the staff are run off their feet, perhaps more staff would be helpful. (Relative) I feel that since my relative has gone there the amount of staff is not enough to meet the patients needs. (Relative) There is a staff rota in place at the home, identifying which staff are on duty and when. On the day of our visit there were six care staff on duty, two team leaders plus the deputy manager and manager. Ancillary staff included a housekeeper, cooks and the maintenance person. During the day there are usually six care staff on duty and one team leader. At night there are three staff on duty. The manager told us that there is a significant number of residents with high care and support needs, many of which need two carers to support them to meet their care needs. Most of the staff at the home have gained a National Vocational Qualification (NVQ)in care at least to level 2. We saw samples of staff training records showing that staff do have access to other training such as safeguarding (abuse), dementia care, first aid, moving and handling, health and safety and safe administration of medication. However, some of this training had not been undertaken for some time and staff would benefit from some refresher training. The manager told us that some safeguarding training is planned for April 2010 and staff are in the process of completing a dementia care training workbook. The organisation has access to an elearning system, although the manager told us that the home is struggling to access this at the moment. The manager told us that the organisation has a Dementia Training Team, which supplies specialist training for all staff. This team has been short of staff over this year so there are staff who still require dementia care training. Some of the staff told us that they usually receive enough support in their work and that they usually have the skills and knowledge to help them understand and meet the needs of the people that live at Kirklands. We found that staff have not had any training to help them work with people who may demonstrate aggressive or challenging behaviour. One member of staff told us; Some of the residents are extremely demanding, the staff need more training on challenging behaviour. Staff all react differently therefore there is no consistency and there is no improvement in the situation. Another member of staff told us; Training is adequate but I would welcome more than just compulsory courses. We dont get training to help understand and meet the needs of people nor do we have enough knowledge about health care and medication. Care Homes for Older People Page 26 of 34 Evidence: Some of the staff participating in this inspection told us that they received induction training that was mostly helpful to their work. They told us that they are provided with on-going training to help keep their skills and knowledge up to date. The manager has not recruited any new care staff since our last visit to the home, but is in the process of recruiting two ancillary staff. We looked at their recruitment records so far completed. Appropriate checks have been carried out and there is a recruitment checklist to help the manager make sure that all the information and checks needed have been received before the person commences working at the home. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service live in a home that is generally well managed and operates in their best interests. Evidence: The manager at the home is registered with us the Care Quality Commission. She has many years experience of managing care services. She has gained managerial qualifications as well as a variety of others such as caring for older people, fire safety trainer, NVQ assessor, skin care and care of medicines. This helps to ensure that the manager keeps her skills and knowledge up to date. The manager completed the Annual Quality Assurance Assessment for the service when we asked for it. She has identified where the home has made improvements over the last year and areas where further improvements are planned. The manager has started to introduce resident meetings to help people using this service voice their opinions and make suggestions with regard the running of the Care Homes for Older People Page 28 of 34 Evidence: home. The manager has told us of a variety of audits and checks that are made to help the home measure itself against national standards and other services within the organisation. This should help the manager to continue to make improvements to the home and to the services on offer there. At our last inspection of this home, we asked the manager to make improvements to the way in which staff are supported and supervised. Staff told us that they receive support and supervision from their manager. They also told us of the staff meetings that are held regularly. Minutes are produced and staff who may have missed the meeting are able to keep up to date by reading them. The staff records we looked at confirm that staff have supervision meetings about every two months. Issues that staff have come across whilst working at the home are discussed but we saw little evidence that staff discuss their training and development needs during these meetings. Staff told us that they generally feel supported by the manager. One person commented; the management always try to make the home run smoothly. Whilst another said; Communication is still a problem and staff often find out information by accident. The manager told us that health and safety checks such as servicing of the central heating, hoists, lift, fire detection system, gas and electrical appliances are carried out regularly. These checks help to ensure that the home maintains a safe environment for people to live and work. There is a policy and procedure in place to help minimise any risks associated with infections and staff have received training in this subject. There are some areas of the home that are not as clean as they should be and this could compromise infection control at the home. We showed the manager some of the areas we were concerned about and told her of the others. We looked at a sample of entries made in the accident book. We found that the manager does not consistently tell us of incidents that have occurred, which may adversely affect the health and well-being of people using this service. We discussed this with the manager as staff at the home need to be aware of what to report and who to report it to. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The way in which medications are managed, including the application of creams and ointments must be reviewed. Staff practices must be monitored to help ensure all medication is managed safely, recorded accurately and administered as the doctor intended. People using this service must receive all of their medication consistently and as the doctor intended. Clear and accurate records help ensure safe and appropriate management of medicines. 31/03/2010 2 26 16 All areas of the home must be maintained in a clean, hygienic condition and free from unpleasant odours. Maintaining satisfactory standards of cleanliness helps to ensure that people 31/03/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action using this service live in a clean and fresh environment, safe as far as practicable from the risks associated with poor hygiene. 3 27 18 There must be a suitable number of skilled and experienced staff on duty at all times to meet the assessed needs of people using this service. This will help ensure that people using this service receive the care and support they require, when they need it. 4 30 18 Staff must receive suitable 30/06/2010 training, which is appropriate to the work they are to perform. People using this service must be supported safely by well trained and competent staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/04/2010 1 1 The Statement of Purpose should be reviewed and updated to ensure it accurately reflects the services and facilities available at the home. Up to date information should be provided as required. Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 8 Clear and accurate records of any healthcare professional involvement should be consistently maintained. This will help ensure that any medical conditions are not overlooked and people receive the treatment they need. Where medications are retained by the resident, including creams and ointment, these should be stored safely and securely. The social and leisure activities available to people who may have special needs, such as dementia, should be reviewed and improved to ensure that all residents have access to a stimulating environment and lifestyle. Consideration should be given to the numbers of housekeeping staff on duty each day to help ensure there are sufficient staff to maintain the environment in a clean condition. Work should continue to develop and progress the quality assurance programme in place at the home. This will help ensure that all residents are supported to have their say about how the home operates. Staff supervision should include discussions regarding individual training and development. This will help the manager to identify any gaps in staff training and to devise a comprehensive staff training and development programme. The manager should ensure that CQC are consistently notified of any event that adversely affects the health and well-being of people using this service. 3 9 4 12 5 26 6 33 7 36 8 37 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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