Action Plan for Kingfisher Lodge Dear Sir or Madam, We thought it might be useful to residents, potential residents, their relatives and friends to summarise our response to the Care Quality Commission s latest inspection report, setting out the actions we are taking to improve care at Kingfisher Lodge. Their most recent inspection took place on the 19 th of September and the report was published on the 2 nd of November. We were grateful that the Care Quality Commission noted some good practice in a number of areas. For example, we were pleased that the Care Quality Commission noted: Staff at the service were caring and their relatives spoke very highly about the caring nature of staff. We made positive observations of care provision. The Care Quality Commission s overall rating for the home was that it was inadequate in two of the five areas that they inspected and required improvement in three other areas, however. We value the Care Quality Commission s view of how we deliver care and apologise for the fact that when the inspection was carried out standards at Kingfisher Lodge failed to reach the levels which we regard as acceptable let alone those to which we aspire. We have already addressed some important issues identified in the report but we recognise that there are areas in which ongoing work is needed. Both improvements in place and areas where new planning is needed were identified at recent meetings, and we want to reassure you that we are taking appropriate actions. We believe that setting out these actions will help everyone interested in care at Kingfisher Lodge to understand our response to people s concerns, our action planning and how we are improving the care we offer at the home. Report findings and actions The Care Quality Commission wanted us to ensure that people s care and treatment is appropriate and always meets their needs. A full audit of all care documentation has been completed to ensure accurate reflection of resident needs.
This audit has been undertaken by senior staff independent of the delivery of frontline services, to ensure than an objective view is taken and the necessary steps are implemented. As care plans are updated the dependency tool will also be reviewed to ensure it is an accurate reflection of residents needs. In addition to daily stand up meetings, there are now daily clinical meeting attended by the Operations Manager and nurse in charge. Priority will be given to those residents where risks are identified with issues such as skin damage, risk of malnutrition or underlying clinical diagnoses such as diabetes. Referrals will be made to specialist members of the wider multidisciplinary team where required. During care plan reviews we ensure that specific plans are in place for the effective and safe management of catheters. Additional training is being provided for care and nursing staff in the management of catheters. Resident of the day meetings take place to focus on the needs of and care delivery to specific residents. Nutrition and choking risk assessments are being reviewed during the care plan review process. Monitoring charts are in place for residents with identified risks. Completion of these charts is monitored by the Operations Manager and other support team members. Staff are aware of their responsibilities in relation to reporting poor fluid or dietary intake, ensuring that it is documented in residents notes. The Chef serves meals to residents in the dining area, allowing care staff to provide support to residents as required. A likes and dislikes document is completed for all residents and provided to the catering team. The Chef is made fully aware of all residents at risk nutritionally. Special dietary requirements are updated as any changes occur monthly nutrition meetings commenced in December. Where required, referrals are made to the multidisciplinary team, which includes dietary specialists. Staff receive copies of relevant policies and procedures to ensure their understanding of their responsibilities. The Care Quality Commission wanted us to ensure that care is always in line with mental capacity legislation and with people s consent. Where there is reason to doubt the capacity of a resident to make a specific decision mental capacity assessments will take place. If a lack of capacity is established assessments will be followed, by a best interest meeting. A Deprivation of Liberty Safeguards (DoLS) assessment will be applied for where necessary. Decision-specific mental capacity assessments will be part of the pre-assessment process. We will undertake a review of resident s records pertaining to mental health and assessments of peoples capacity and consent, with the associated best interest decisions.
All outstanding Deprivation of Liberty Safeguards assessments will be applied for as a priority. Deprivation of Liberty Safeguards currently in place will be reviewed to ensure that any conditions applied are fully documented in the associated care plan. A review of all residents will be undertaken to establish where bedrails and sensor mats are used to ensure appropriate consent has been obtained. Mental capacity assessments will be rewritten to specify what they pertain to, in particular whether this leads to a restriction or deprivation of liberty (e.g. the use of bedrails, the use of sensor mats and the delivery of personal care) or actions agreed as in someone s best interests. The Care Quality Commission wanted us to ensure that we do all that is reasonably practicable to mitigate risks to people and that we manage people s medicines safely. We met with Boots pharmacy to discuss medication management, procedure and joint working. Learning from the sessions will be disseminated to the care staff via staff meetings and supervision. We asked all General Practitioners and involved pharmacists to review resident medications and reduce them where appropriate. A homely remedy agreement is in place for all residents where necessary. All Registered Nurses have completed Boots Care of Medicines training, with additional face-to-face training as required. All nurse medication competency assessments were repeated. Dates were recorded on the learning and development database as well as the training matrix. Local medication policy and procedures were reviewed and updated to ensure all information is accurate and applicable to Boots. All as required (PRN) medication protocols are reviewed and signed off as appropriate during Resident of the Day meetings. Mealtimes are protected, with no administration of medication other than time specific or meal-specific prescriptions. All senior carers now hold a valid competency assessment for witnessing controlled drug administration. All Medication Administration Records are being reviewed and rewritten, ensuring they are an accurate reflection of resident s prescriptions. Medication Administration Records are completed as required by staff - constant checking and practical supervisions are undertaken to ensure a new culture is embedded. Medication Administration Records are audited each evening by night staff to ensure early identification of any issues such as missing signatures or stock balance checks documents are in place for evidence that records have been completed. Gap analysis sheets are used effectively, allowing prompt action to be taken if any issues are highlighted. Weekly medication audits are completed by the Clinical Lead Nurses who are currently supporting the home, with gradual transference to nurses in the home.
Weekly checks of all controlled drugs take place, documented and signed by two competent individuals controlled drug records are presented at each Monday s clinical handover. Staff have been made aware through handover that any accident or incident must be reported to the manager in charge that day and the relevant documentation completed. Accident and incident forms are reviewed and signed by the manager allocated to the task on rota for each day. They ensure that care plans and risk assessments are updated as well as entered on the clinical governance database. All reported accident or incidents are reviewed remotely at least weekly via the clinical governance database and followed up during site visits where required. Any common themes or trends are reviewed by the care team. Actions are implemented to mitigate risks where this is possible. Referrals are made to the multidisciplinary team as required. The Care Quality Commission wanted us to ensure that clinical governance is always used effectively to assess, monitor and mitigate risks relating to the health, safety and welfare of service users. There is a weekly review of all documentation relating to tissue viability and wound management for those residents currently identified as having skin damage audit forms are retained in an evidence file. The Safety Cross monitoring tool for pressure damage management is maintained daily in each unit and discussed at stand-up meetings. A root cause analysis is completed for all home-acquired pressure ulcers of Grade 3 or above and findings are shared with teams at clinical meetings. BHC clinical governance system are updated within a maximum 48 hours of any skin damage being identified, ensuring where required statutory notifications are completed. During care plan reviews we now ensure that all documentation relating to tissue viability correlate and that planned actions are being adhered to by all staff. Staff ensure appropriate equipment is in place for those residents with current skin damage and those identified as being at risk. The manager for the day ensures repositioning charts are completed accurately and in a timely manner by all staff the senior team monitor this on a daily basis. Staff are aware of the need to report and document any signs of skin damage or bruising to the nurse in charge, make a record in the daily evaluation notes and complete an accident or incident report which is given to the Operations Manager for review and investigation, recorded on clinical governance and reviewed by clinical leads and the Regional Director. Daily stand up meetings take place with all Heads of Departments, followed by a clinical meeting with the Registered Nurse in charge of each unit. As care plans are reviewed by the care team the file is reviewed by the Operations Manager and signed off as complete and accurate. A review of the clinical governance database takes place as above.
The Care Quality Commission wanted us to ensure that sufficient numbers of suitably qualified, competent, skilled and experienced staff are deployed in order to meet people s needs. An experienced Operations Manager has been deployed at the home to provide support to the home. Her presence will be ongoing. Care staff levels have been increased since the week commencing 11 th September. The home is currently operating with 18% higher levels of care hours than at the time of inspection. These hours will remain in place until required changes have been made and we are confident that the resident assessments are an accurate reflection of current needs. A review of the duty rota is completed daily, ensuring that there are sufficient staff to meet resident needs. A meeting was arranged with our agency supplier to ensure continuity of care by supplying regular staff. Agency staff are booked four weeks in advance. A review of daily allocation is undertaken, ensuring staff are deployed appropriately throughout every shift. Back to work interviews are held for any staff member absent from work. High level monitoring by the additional Operations Manager was introduced to the service in October and this will continue until improvements ensure the service is well-led A daily feedback forms was developed to allow relatives and residents the ability to provide real time feedback following their day or visit these are reviewed on a daily basis by the Operations Manager. There is ongoing monitoring of accidents and incidents to identify trends and peak periods of activity. Accountability for change We are pleased that the Care Quality Commission noted some areas of good practice at Kingfisher Lodge. For example, they recorded that: Relatives we spoke with confirmed they were involved in all decisions regarding their loved one s care and were kept informed of any changes, that residents said: Staff are really nice I get on well with staff, I am treated with dignity, they know what I like, and: Everything about here is good, the staff are all kind and I m lucky to be here. We take very seriously the Care Quality Commission s view of how we deliver care and recognise that we need to improve services at Kingfisher Lodge, which were not meeting the standards Barchester sets itself at the time of inspection. We are working hard to ensure that we meet Care Quality Commission requirements for improvements, that we improve our working practices.
We are monitoring our progress carefully, audited through regular visits from senior managers: our progress will also be monitored by the Care Quality Commission. As newly appointed Operations Manager for Kingfisher Lodge these actions are currently accountable to me. If you would like to talk about any of the issues this raises I and my team would be pleased to do so. Sincerely, Lesley Cole, Operations Manager, 07/11/2016