Care Home: Kirkley Manor

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What the care home does well The home provides a good standard of care in a comfortable and well-maintained environment. The work of the staff is appreciated by many residents and relatives. Comments included: `The carers really do work hard and are always very pleasant and make you feel welcome`. `Staff seem lovely towards my relative: caring, affectionate, cheerful and teasing, which my relative loves`. There is a comprehensive quality assurance system in place, which gives residents and others opportunities to have their say about their care and about how the home is run. It also provides protection for residents by ensuring their health and safety through regular checks and proper maintenance. There is a training plan for all staff and many opportunities for them to improve their competence to provide good care to the residents. What has improved since the last inspection? The home has a continuing programme of upgrading the building, and replacing furniture and furnishings, to give residents a more pleasant and hygienic environment. The full time activities organiser has been joined by a part time person to increase the range of opportunities offered to residents. This has enabled more attention to be paid to meeting their individual wishes. A monthly newsletter has been introduced to keep residents and relatives up-to-date with events at the home, and to inform them of changes. Life story books are being introduced to give staff a deeper knowledge of the person`s background, their family and their work history. This will help them plan their care and provide opportunities to engage them in activities related to their experiences. The reception area has been moved and is manned during the week. A suggestion box has been installed there. A person-centred care plan system has been introduced. This allows the resident, or someone on their behalf, to express their needs and wishes from their point of view. It focusses on how the person thinks and feels, to emphasis that the care plan belongs to the resident. New medication protocols for `as required` medication have been introduced, to make clear when and why such medication was given, and the result . What the care home could do better: The care planning audits should ensure that all care records accurately reflect the current needs and progress of residents, to enable proper reviews of their care to be done. Particular attention should be paid to the nutrition and turning records, guidance and risk assessments.There should be a review of the organisation and staffing of Kingswood to ensure that the special needs of people with dementia are met. The dignity and privacy of residents should be protected by all bathrooms and WC doors being capable of being locked. Key inspection report Care homes for older people Name: Address: Kensington House Nursing and Residential Home 3 Kirkley Park Road Lowestoft Suffolk NR33 0LQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: John Goodship     Date: 1 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Kensington House Nursing and Residential Home 3 Kirkley Park Road Lowestoft Suffolk NR33 0LQ 01502573054 01502513862 adrienne@kingsleycarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kingsley Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 71 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home The home is registered for 71 service users in 51 single rooms and 10 shared rooms. Of these, 45 rooms have en-suite facilities. The home has grown up around the original large Edwardian house, and is set in welltended grounds, to the front and rear. The provision of accommodation is suitable for older people with mobility problems, with appropriate aids and adaptations fitted, although the shaft lift is not modern - being fitted with a heavy, hand-operated outer door, and an internal iron grill cage door. Consequently, some service users may find Care Homes for Older People Page 4 of 32 Over 65 71 54 0 71 0 5 Brief description of the care home this difficult to manage on their own. Kingswood unit is a newly built, self-contained dementia care unit that has been added to the rear of the home, and provides modern, comfortable accommodation for 17 persons with dementia. In addition, the main building can now accommodate persons with dementia, who require nursing care. The home is also registered to care for five people with physical disabilities aged between 50 and 65 years. At least one nurse is on duty at all times. There is a competent team of care staff, assisted by a full complement of ancillary workers. The home is operated by Kingsley Care Homes Ltd, which owns a number of other care homes in East Anglia. The Company Directors are regularly on the premises, as is the Operations Manager. The company also has a director of Quality and Compliance who provides support to the home. At the time of this inspection, the range of fees was £362.00 to £650.00 per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We inspected this home unannounced. It is the policy of the Commission that two inspectors will normally visit a home with over sixty places. We focussed on the outcomes for residents by spending time in different parts of the home, observing staff and residents, and inspecting the environment. We spoke to two residents, three relatives and two staff in detail, as well as chatting to several others of these groups as we went round the home. We also followed the care of four residents through their care plans, by talking to them and to staff and observing their care. We also examined staff files, training records, audit records, health and safety records and discussed topics with the manager. For some of the visit, the companys operations director and the director of nursing were able to be present. Before the inspection, we had sent out a questionnaire survey to residents, relatives, staff and NHS professionals to seek their views of the home. Fifteen relatives replied, Care Homes for Older People Page 6 of 32 eight residents, four staff and two NHS professionals. Suffolk County Council had also surveyed some of the relatives of residents funded by the authority. Twenty had replied and the results of this survey were available to us. The manager had also completed an Annual Quality Assurance Assessment for us. This gives the manager the opportunity to describe what the home does well and how it plans to improve. Information from all these sources has been used in this report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The care planning audits should ensure that all care records accurately reflect the current needs and progress of residents, to enable proper reviews of their care to be done. Particular attention should be paid to the nutrition and turning records, guidance and risk assessments. Care Homes for Older People Page 8 of 32 There should be a review of the organisation and staffing of Kingswood to ensure that the special needs of people with dementia are met. The dignity and privacy of residents should be protected by all bathrooms and WC doors being capable of being locked. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to have access to the information they need to make an informed choice about the home, and to have the opportunity to visit the home before deciding whether to live there. Evidence: We read the homes Statement of Purpose and the Service Users Guide. Between them they covered all the items of information to enable prospective residents to decide if they wish to live there. The accommodation was described together with the associated facilities. The training and qualifications of the management and the care staff were listed. Both documents set out what the fees covered, and what residents would normally pay for themselves. It said that fees would vary depending on needs and type of accommodation. At the time of our visit the fees ranged from £362 to £650 per week. These included all care and accommmodation costs, food, drink,and laundry done on the premises. In addition, the Service Users Guide gave details of the care planning process and the ways in which residents could be involved in that Care Homes for Older People Page 11 of 32 Evidence: process if they wished. It also said that residents had a choice of whether to take their meals in the dining room or in their room. The way in which a resident could raise a complaint was detailed, and the two documents had been updated in June 2009 to give the new address for the Care Quality Commission. The above documents informed residents that all new admissions had a six-week period to decide whether this is the place for you. From our survey, five people said that they received enough information to help them decide if this home was the right place for them, and that they had received a contract. Two people had ticked Dont know. The contract terms and conditions were included with the Service User Guide. It advised residents that a copy of your agreement will be supplied to you once signed by both yourself and the home. On previous visits, we were shown examples of contracts, which were signed by residents or their representatives, both those fully funded by a local authority, and those funded partly or wholly by themselves. We examined three residents files. All contained pre-admission assessments, two of them incorporated a social care single assessment, and the third incorporated a hospital discharge record. The assessments covered all areas of care and daily living, and could be followed up in the care plans produced upon admission. The manager told us that potential residents were offered a trial visit when they may attend lunch and participate in activities, but few were able to take up this opportunity. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect staff to identify and review their care needs with their involvement to ensure that appropriate care is given. Evidence: The AQAA told us that new person-centred care plans had been introduced since the last inspection, and a regular auditing system was being introduced. We saw evidence of this in one care plan which recorded that the plan had been audited in July by the Head of Care. One of the plans showed that it had been signed by the resident in July 2009. The Newsletter for July 2009 said that we review residents care plans once a month. We would like you and your relatives to be involved...... You are welcome to see and discuss your care plan any time. Time spent talking to the nurse on duty in the main home helped us identify three residents, with higher care and nursing needs, whose care we could track whilst at the home. Tracking included looking at their care plans (a document which gives staff guidance on how the residents care and nursing needs are to be met), to see if the information given reflects what level of care the residents themselves tell us (if able) Care Homes for Older People Page 13 of 32 Evidence: they are receiving, and staff tell us they are giving. At the front of the care plan, there was a care plan summary sheet, which gave staff a working knowledge of the level of support the resident required, along with their health and nursing care needs. This was especially useful in supporting new and agency staff, in getting to know the residents needs, where they may not have time to read the whole care plan. Care records contained details of visits from GPs, chiropodists and community nurses. We noted that a GP had been called in by the staff to attend a resident on the Kingswood unit that morning as they were concerned about their refusal to eat. A referral had been made to the dietitian. Another resident was to be visited by the continence adviser to assess their needs. We saw in the records that one resident had been assessed by the occupational therapist for a walking aid after a fall. We spent time with two of the three residents whose care we were tracking, who when asked, indicated to us that they were comfortable. Both were being nursed in bed at the time, and were being assisted with their diet and fluids. Extra care records held in the bedrooms showed that staff were regularly repositioning the resident on bed rest to prevent their skin breaking down, and pressure sores developing. We discussed with the nursing staff that we could not see in the care plan, or care records held in the rooms, guidance to care staff on how regularly the resident was to be repositioned and offered drinks, especially taking into account it was a warm day. When we looked at the sheet at 4:00pm, the resident had been given fluids at 10:15am that morning,11.15am, 12 midday, and 2.45pm. We were informed that some days the resident was able to get up and have a meal, and staff would record this in their food diary. When we went back into the residents bedroom, after staff had repositioned the resident, the resident was more alert, and smiled when we asked if they were comfortable. The third resident had recently been discharged from hospital, where they had unfortunately developed pressure sores. Care records showed that nursing staff were closely monitoring the sores, which were beginning to heal. However, when reading the care plan we could not identify what had happened whilst the person was in hospital to require them to be re-assessed and now requiring a liquidised diet. We asked nursing staff if they were aware why, but they were unable to tell. We also asked if the resident had been re-assessed by staff at the home, prior to them being discharged from hospital. We were informed that normally this would happen, but they were unable to find, at the time, any information relating to this. Care Homes for Older People Page 14 of 32 Evidence: The Commission had received concerns about the care and treatment of pressure areas at the home. The manager told us that the district nurses were now allocated to specific homes which allowed advice on best practice to be given and monitored regularly. We looked at the record for one resident who had three areas of different levels of seriousness. The body map was completed and dressing notes made every two to three days depending on the dressing being used. The notes recorded that progress was being made on their treatment. Staff were trained to use the Malnutrition Universal Screening Tool (MUST) to assess and monitor the risk of poor nutrition and its consequences. Some records that we saw were up-to-date but another had not been reviewed since April 2009. Since then, we calculated that the risk level for this resident had changed from low to high. However the care plan summary reflected the persons actual condition and the changes. The staff were taking appropriate action to closely monitor the residents fluid and diet intake, by keeping a daily food diary. This showed clearly what the resident had to eat, and where fluids were being encouraged. The AQAA told us that life story books were being introduced to give staff more help with knowing the resident better, and planning their days around their interest and background where possible. The manager told us that relatives had been asked to help by bringing in photos and filling in gaps in the persons life story. Each resident would keep the original full colour version in their room, and the home would keep a copy. We saw one of the books, which covered memories of school, their job, their family and what they like doing. The Commission had received concerns about the number of residents testing positive for MRSA when they were admitted to hospital. The local general hospital now tested every admission from all sources. It was not clear whether the incidence at the home was significantly different from the incidence in the older population at large. However the home had sought advice from the infection control staff at the hospital, one of whom had visited in April to advise on procedures. Only minor changes were recommended. One of these was the need for laundry bins to be covered. We saw that this had been done during our inspection. The home had nominated three staff to be infection control champions. They attended meetings at the hospital every three months to keep up-to-date with the latest advice on good practice. Part of each plan that we saw included an Advance Care Plan - thinking ahead. This enabled residents, or if appropriate their relatives, to express their views on where they would like to be looked after at the end of life. The Plan enabled the resident to Care Homes for Older People Page 15 of 32 Evidence: state their preferred place of care, their views on resuscitation, funeral arrangements, and information on executors or legal advance directives. The plan also identified which staff were involved in discussing these matters with the resident. Following a concern from the relative of a resident who had moved to another home, the manager had put in place a discharge checklist to prevent items going missing, and had instructed staff not to pack clients clothing on discharge unless a relative was unable to do so. We observed part of the lunchtime medication round. It was undertaken by a nurse who followed the proper procedures to ensure residents received the correct medication. The medication administration records (MAR) we examined contained no gaps in signatures. Where the resident had been prescribed a drug PRN (as required), the home used a separate record which gave details of the time and dosage, and the result of the administration, usually for pain relief. We observed staff being attentive and patient with residents, and showing sensitivity to their needs. Staff knocked on residents room doors before entering. However we found residents privacy and dignity may be compromised, where a bathroom and a shower room (both of which staff confirmed were used by residents) had not been fitted with locks. Also on reading in a care plan that a resident who we wish to visit preferred not always to be fully clothed, we asked a member of staff if they could check with the resident first. However, the member of staff knocked on the door, and walked straight into the bedroom, holding the door open for us to follow, without asking the resident first, which could have put the resident in a potentially embarrassing situation. We fed back our observations back to the manager, who promised to look into and address the situation. Information held in the care plans showed that residents were being asked their preference, on which gender provided their personal care. A relative told us: The nursing care is good. They keep me informed about Xs health and issues with their diabetes. Another wrote in their survey: Kensington House has improved greatly over the past two years. They seem to cope with my relative very well. Another wrote: Informs me of my relatives needs eg for new clothes. Deals promptly and sympathetically with their incontinence. One relative who lived some way away said they would like to know beforehand if things were needed. A relative wrote: I am extremely pleased at Xs progress. Since becoming resident, they have gained weight and responds more positively. Overall, the residents who replied to our survey told us that they received the care and support they needed, and received the Care Homes for Older People Page 16 of 32 Evidence: medical care they needed. Thirteen out of the fifteen relatives who replied to our survey said that the home always or usually met the needs of their family member. Care Homes for Older People Page 17 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect social activities to be organised to suit their interests. They can expect to receive wholesome meals, although not always served at the correct temperature. Evidence: The AQAA told us that the home intended to use the life story books, described under Health and Personal Care, to gain a deeper knowledge of residents backgrounds so that we can tailor activities around their wishes. Since our last inspection, a second part time activities assistant had been employed to join the full time one which the AQAA told us enabled the home to give more one to one interaction. Unfortunately the full time person had been away for some time. The other activities assistant was combining some caring duties with activities on the day of our inspection to try to maintain an activities programme. The recently introduced monthly newsletter, written by the activities co-ordinator, advertised that we have activities daily. The newsletters for July and August reported with photos on outings to the Lowestoft air show. It advertised future events, such as carnival day, and a Polish Day. Church services were listed, as well as a residents/relatives meeting. The newsletters also told people about the visit of the Care Homes for Older People Page 18 of 32 Evidence: mobile library once a month, where tapes as well as books could be borrowed, about the new garden furniture, the introduction of budgies to the Rose Lounge and Kingswood, and the hire of a Wii games console which several residents were trying out. The newsletter also described the sensory boards which we saw on the corridor walls. Relatives had been asked to donate materials for these which had been assembled by two students on work experience. More would be completed for Kingswood in the coming weeks. The activities programme listed many group activities in the home such as bingo, quizzes, singsongs and exercises. We have seen these happening on previous inspection visits. However we did not see any of these this time, possibly because of the absence of the co-ordinator. The dining room had been equipped to double as a cinema. The statement of purpose described the home as having a snoozelen room. This was a room designed for relaxing residents who had become agitated or upset. It was also a communal room so was not particularly suited to be shut off to give an atmosphere of quiet and calm. However we were told that it had proved particularly helpful to those with dementia. Where a resident had voiced their views and wishes, staff wrote an action plan to identify how they would support the resident to achieve this. However, where we read in one care plan that the resident had said they would like to go out in the fresh air, and for staff to assist me in getting outside when the weather is good, we could not see any evidence of staff supporting the resident to do this. The menu ran on a four week cycle. It was displayed on noticeboards and included a choice of main dish and dessert. In the main dining room, some residents could not tell us which dish they had chosen, but staff asked them at the table which one they would like. In the Kingswood unit, a member of the kitchen staff came round at 12:30 and showed those in the sitting areas the two main dishes served on the plates and asked them to choose. That day it was shepherds pie or lamb casserole. A visitor commented to us that it was a pity they were both lamb dishes. The manager told us that there were two sittings for lunch. A relative told us that if they were taking their family member out, the meal would be brought earlier. Residents from Kingswood could eat in Kingswood or go to the main dining room. When we asked people why they had not chosen to eat in the main dining room their comments included its such a muddle - just watch people coming in and out and so many wheelchairs no sooner get in - your in someones way. The management Care Homes for Older People Page 19 of 32 Evidence: explained that once a table is cleared in the dining room, it is re-laid, ready for the next sitting. However the way residents from Kingswood were taken to the dining room was very muddled. Different staff came into the sitting area quoting different numbers of spaces available in the main dining room. We noted good practice on Kingswood when staff took two jugs with different flavoured squash around each person and asked them which they would like. When the lunch arrived on Kingswood at 13:30, it was not on a heated trolley although the gravy was in a thermos flask.The main dish was lukewarm when we tasted it. Discussions with the duty Chef identified that once the food had been plated, and sent to the unit, no checks were made to ensure the meal was warm. They went on to say that they could do that tomorrow. The trolley also had ready-plated desserts. A staff member did not know which ones were suitable for one of the residents with diabetes. Staff were covering the two sitting areas on Kingswood and were also taking their own breaks at different times. As there was no staff around in the lower dining area, there was no one to supervise, and make the dining experience a positive social interaction. We comment on staffing levels under Staffing. This contrasts badly with the main dining room which was laid with attractive tablecloths and table mats. Extra staff were also available here to serve and to support residents eating their meal. In our survey, the answers to the question to residents : Do you like the meals at the home?, were evenly spread over Always, Usually and Sometimes. Two residents told us that some days the food was good but the standard was not consistent. Depends whose cooking it. One relative wrote in their survey that: The absence of carers while they attend to residents needs other than lunch has left some residents alone waiting for assistance. In the morning we noted that the TV was on in the main lounge near the office. The programme was not one which was likely to be of interest to those residents in that room. One of them told us; load of old rubbish. I would like a film. Dont have many good films. In the afternoon, we noted that an old black and white film was on the screen. The resident liked it, but the person sitting next to them did not. There was a quieter area across the corridor as an alternative. However our impression was that most residents always sat in the same area unless there was an activity on. We spoke to three visitors to Kingswood in the afternoon. One said that they looked after their family member well. The other agreed. The third visitor said there was not Care Homes for Older People Page 20 of 32 Evidence: enough staff, and this meant their family member often had to wait too long to be taken to the toilet as two staff were needed to move them. We were disappointed to note that one of the residents with a visitor had the remains of their lunch down their trousers. This reduced their dignity. Care Homes for Older People Page 21 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be able to raise complaints and concerns and have them acted on. Evidence: The documents issued to prospective residents contains details of the complaints procedure. There was also a folder for residents, relatives and visitors in the reception area containing all relevant information about the home including the complaints procedure. The August monthly report reported that there had been seven complaints to the home this year and that all had been resolved satisfactorily. In our survey, some residents said they did not know how to complain, but most of the relatives who replied said they did know. A relative wrote:Sometimes we get the odd minor issue but this is normally sorted out promptly. However, there have been six adult safeguarding referrals since January 2009. Two of these had been referred by the home manager. One had been referred by an outside agency, and three had been referred by a social worker and related to the same resident. These latter referrals led to the Suffolk County Council requiring the home to investigate the issues around one resident. A director of the company produced a thorough report with all relevant documents. The home was also required to produce an action plan to improve thirteen areas. Until this was received and the action Care Homes for Older People Page 22 of 32 Evidence: confirmed, the Council suspended the accreditation of Kensington House from 4th June. This meant that there would be no referrals from Adult and Community Services social workers during this time. An unannounced inspection visit was made by the Councils Outcomes and Quality Monitoring team on July 10 2009. A survey of relatives was also undertaken. Progress was such that the suspension was lifted on July 13 2009. Information in the councils report, and the action taken by the home, have been included in relevant parts of this report. The home had a policy on the protection of vulnerable adults (POVA) which was up-todate and in line with the Suffolk Adult Safeguarding Board procedures. Staff received initial training on this procedure at induction. Further training followed if they were placed on an NVQ Level 2 course. In addition, the homes policy was to require all staff to attend refresher training once a year. This was confirmed in the annual training plan. The manager told us that twenty staff were waiting to start a further training course by distance learning using the Skills For Care workbooks. Staff files showed that no staff were employed until POVA checks were received, followed by Criminal Record Bureau(CRB) certificates. Care Homes for Older People Page 23 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the home provides a comfortable and hygienic environment. Evidence: Since the last inspection, the main entrance to the home had been moved away from the old front door to the door opposite the nurses station. This entrance incorporated a shallow ramp for wheelchair users. There was a reception area inside with a receptionist during the day. We were asked to sign the visitors book. A suggestion box had been placed by the book. We were told that the corridors in the main building were to be re-carpeted before the end of the month. Samples of the carpets were in the office and we were shown the order. During the feedback session, we expressed our view that the carpet in the lower sitting area on Kingswood was very dirty and marked. The operations director agreed to include this in the re-carpeting. We noted that two bathrooms had no lock. Staff told us that both rooms were used by residents. One bedroom door was wedged open and needed an automatic closure like the others. On Kingswood, bedroom doors had the residents name with a picture relevant to their Care Homes for Older People Page 24 of 32 Evidence: life or interests. Memory boxes were also on the doors containing small items from the residents past. The doors in the nursing unit only had large numbers and this was less helpful for those with dementia who required nursing care. Over 95 of respondents to the surveys agreed that the home was kept clean and free from offensive odours. Several comments were made about the laundry system.All their clothes are labelled but they have lost 25 of them since being in there. They sometimes get other peoples clothes back and I dont like them wearing them. Things go missing and when you say something it seems it is pushed aside and nothing is done. The laundry used three washing machines and three dryers, and was staffed by a laundry assistant. The homes policy is that all clothing must be labelled, and the home did not take responsibility for the loss or damage to clothes being laundered. As the laundry cost is included in the homes fees, the home should reconsider its responsibility for clothes that are correctly labelled but go missing. The manager said that they look at this on a case by case basis. On the other side, the housekeeper told us that there was a big pile of unlabelled clothing. The August newsletter asked families to come and have a look at them before they are disposed of. We have reported on control of infection measures under Health and Personal Care. The procedures and systems were in place and staff understood them. Alcohol hand gel dispensers were placed around the home, principally for visitors, as the manager told us that hand washing was the main control measure. The monthly report described the concern of a relative about the smell in their family members room. The manager had arranged for a new carpet to be fitted. It had been on the list for replacement, but was brought forward. It was reported that the family were very happy with the response. Care Homes for Older People Page 25 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for by well-trained staff, and protected by the homes recruitment process. Evidence: We examined the staffing roster and compared it with the number of staff on duty during our visit. There were eight care staff and two nurses on duty on the early shift, and six care staff and a nurse on the late shift. At night there were three carers and one nurse on duty. Three of these staff, including a nurse, were allocated to Kingswood. Due to sickness, one of the carers on Kingswood was covering activities as well as care tasks. The AQAA told us that no agency staff were used. The manager added except in an emergency. The home employed waitresses for lunch in the main dining room, and two activities co-ordinators. The staff surveys told us that there were always or usually enough staff on duty, except one person who said only sometimes were there enough. We have commented under previous headings that the staff on Kingswood seemed stretched to cover the needs of the residents there. With two staff needed to move several residents, and trying to serve the meals in a timely way while taking their own breaks, it did not appear that staff had any opportunity to give time to residents who wished to talk. However the residents survey told us that there were always or usually staff available when they needed them. In the Councils survey, 45 of Care Homes for Older People Page 26 of 32 Evidence: respondents did not agree that there were enough staff to support all residents needs. There was general agreement in both surveys that staff were able to maintain a high quality of care. A sample of comments were: The care is excellent, caring, understanding, kind. The carers are always helpful,pleasant and smile when visitors enter Kingswood. The staff are usually very good. There always seems to be plenty of staff on duty. But they seem to be very tired. Two NHS professionals thought the staff were caring, and asked them for advice appropriately. Things have improved with the introduction of skilled, caring staff. We examined the homes annual training plan which showed that all care staff received training in the mandatory topics each year. These included moving and handling,health and safety, control of infection, protection of vulnerable adults,hazardous substances,and fire procedures. Staff with First Aid and Food Hygiene certificates attended three-yearly updates. Documents and certificates in staff files confirmed that these courses had been attended. We saw notices about other training sessions taking place in August including tissue viability, venepuncture, advanced dementia, fall risk training, and managing aggression in dementia. The AQAA told us that sixteen out of 48 care staff had NVQ Level 2 or above. Nine staff had started their NVQ Level 3. The majority of care staff do not have English as their first language. Several relatives commented on the difficulties of communicating with them although they were otherwise happy with the care. We noted that we had to speak and listen carefully when talking with some of the staff to ensure full understanding. However other staff had a good command of English and were able to chat and joke with residents easily and clearly. The manager showed us that thirty one staff were booked onto an ESOL course to improve their written and spoken English. We examined two files of recently appointed staff. Both contained full application forms, identification documents, two references and photo ID. Both had a CRB certificate. Training records were also in their files. Care Homes for Older People Page 27 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to consulted on their views about the running of the home to ensure it is run in their best interests. Residents can be assured that the homes quality assurance system protects them by ensuring that the home is safe. Evidence: The registered manager had been promoted to Operations Manager, covering several homes. The new manager told us that she would be applying to be registered. She had previously been working at the home as the clinical lead. The provider operated a comprehensive quality assurance system. Monthly visits were made by a director and their report met the requirement of regulation 26, giving residents and staff the opportunity to comment on the home and the quality of care. We saw the report for August 2009 which included discussions with three residents, 2 relatives, and four care staff. Four action points arose from the visit, concerning accident reports, auditing care plans, training, and ordering new furniture and towels. Care Homes for Older People Page 28 of 32 Evidence: Following comments from previous in-house surveys, the home now held regular residents meetings. The next one was advertised as due at the end of August. Name badges had also been introduced at the request of residents. This years survey to residents, relatives and professionals had been sent out but the results were not yet available. The home undertook a number of audits to check on the quality of its care. The manager did medication audits. One audit noted that some changes to medication were not being signed for and dated, especially medicines that had been stopped. Care plans and infection control audits were also in place. Accident records were audited although the monthly report required an action plan to be written demonstrating that accidents were being reviewed. We noted that an audit in June 2009 had identified the risk to one resident after a fall. The falls prevention team from the health trust had visited and their risk assessment had been revised. Health and safety checks were undertaken by the Building Services manager, including fire alarm tests, hot water checks, and emergency lighting. We also saw servicing contracts for lifting equipment and for the lifts. We saw the records of staff supervising sessions, which took place at two monthly intervals. Annual appraisals were also undertaken. Staff meetings were held by department. The home did not hold any monies on behalf of residents. Any costs they incurred, eg for hairdressing, and personal requisites, were bought by the home and invoiced monthly to the person or organisation responsible for fee payments. The report describes under other Outcome groups that not all records of residents care were up-to-date or accurate. Therefore their best interests were not completely safeguarded. Staff received regular supervision and annual appraisals. These were up to schedule. The manager told us that senior staff did occasional unannounced night visits to check that care quality was being maintained. After one visit, a staff member was moved to day duty to check their competence and care practice. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 All records of care should be up-to-date and accurate, and reasons given where a particular record is no longer needed. This is to ensure that residents are receiving the appropriate care. The use of the nutrition screening tool should be monitored to ensure that residents dietary needs are being met. The method of transporting and serving meals in Kingswood should be reviewed, to ensure residents receive hot meals, from knowledgeable staff, in a timely way. All bathroom/WC doors should be capable of being locked, to ensure the dignity of residents. The organisation and numbers of staff on Kingswood should be reviewed to ensure that the special needs of people with dementia can be met. 2 3 8 15 4 5 19 27 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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