CARE HOMES FOR OLDER PEOPLE
Kelso 10 Clifton Road Southbourne Bournemouth Dorset BH6 3PA Lead Inspector
Amanda Porter Key Unannounced Inspection 20th October 2006 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000020474.V314524.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000020474.V314524.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kelso Address 10 Clifton Road Southbourne Bournemouth Dorset BH6 3PA 01202 432655 F/P01202 432655 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Kenneth Alan Ackrill Mrs Angela Elizabeth Ackrill Mrs Angela Elizabeth Ackrill Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places DS0000020474.V314524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. NVQ4 in Management to be successfully completed within 18 months of date of registration by applicant - Mrs Angela Ackrill. 24th January 2006 Date of last inspection Brief Description of the Service: Kelso is a private nursing home that is registered to accommodate 12 people in the category of old age (OP). The home is owned by Mr & Mrs Ackrill and Mrs Ackrill is the Registered Manager. The staff team work closely with her in respect of the day-to-day management of the home and a registered nurse is on duty 24hrs each day. The home is located in the Southbourne area of Bournemouth, close to the seafront, shops, pubs, and post office. The home was opened in 1988 and consists of a two-storey building with a large lounge/dining room. Four of the home’s bedrooms are single, and four are double rooms. Residents’ bedrooms situated on the first floor are accessed by the main stairs or a passenger lift. The communal assisted bathroom is situated on the first floor and separate toilets are available at both levels. The home provides residents with nursing and personal care and all services including, meals, cleaning and laundry. The home has gardens to the front and rear of the building: these are well maintained and easily accessible with the aid of a portable ramp. DS0000020474.V314524.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 20th October 2006 and took four hours. The purpose of the inspection was to assess all of the key standards. The registered provider and manager, Mrs Ackrill, and her staff were on hand to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • 10 comment cards completed by residents; relatives/visitors and health and social care professionals. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Three residents and four members of staff were spoken with and asked their views on the service provided at Kelso Nursing Home. Comments received in comment cards and through discussion included: “Mum is very settled and much better cared for than the previous 2 homes. We are always welcomed and can see how much care the staff show towards my Mother.” “I am very satisfied with care and attention my friend gets. The staff are wonderful.” “We are very lucky to have Mum in such a nice clean and friendly home. The staff are kind and happy people.” “The staff are angels.” “The care from staff is excellent.” All the staff and residents were welcoming and helpful. What the service does well:
Kelso provides a very homely and comfortable atmosphere and residents are well cared for. They find that staff are kind, considerate and knowledgeable The home carries out thorough assessments prior to residents moving in and assurances are given that individual needs can be met. DS0000020474.V314524.R01.S.doc Version 5.2 Page 6 Care plans are clear and easy to follow so that staff know how to care for the residents living at the home. Each one is regularly reviewed with the resident and any chosen representative. Residents’ health needs are well met by the home and community health professionals. Residents are confident that staff will treat them with dignity and that their right to privacy is upheld. Residents said that the lifestyle experienced in the home matches their expectations and preferences. Residents are encouraged to maintain their links with family and friends and visitors to the home are made most welcome. Residents are helped to exercise choice and control over their lives as far as possible. The home offers a good variety of home cooked food, which is enjoyed by residents. The complaints procedure reassures residents that their views are important to the home and that any complaints they raise will be properly investigated. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff find easy to follow. The house and gardens are generally well maintained and this provides residents with a very comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. Adequate numbers of staff are employed and deployed to care for the number and needs of residents accommodated. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk. Kelso has an ongoing training programme for staff, which means that residents will be cared for by skilled staff. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff were protected by the policies and procedures that the staff followed at Kelso at the time of inspection. DS0000020474.V314524.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000020474.V314524.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000020474.V314524.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: Care files for two residents were seen and each contained a pre-admission assessment, which contained very detailed information about each residents needs and preferences. This information was then used to draw up a plan of care. The prospective resident and family members had contributed to the assessment and visits to the home prior to admission were encouraged. Prior to admission Mrs Ackrill confirmed in writing that the prospective resident’s needs could be met at Kelso. DS0000020474.V314524.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear care planning system in place to make sure that staff have the information they need to meet residents needs. The health needs of the residents are well met with evidence of good support from staff and community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents are treated with respect and their right to privacy upheld. EVIDENCE: The care documentation for two residents was reviewed. Files contained a variety of assessments from which information was used to formulate plans of care. Care plans were easy to read, to the point and very informative. They
DS0000020474.V314524.R01.S.doc Version 5.2 Page 11 clearly set out individual care needs and how they are to be met. Plans were clear about what residents can do for themselves and what staff need to assist them with. Residents and/or their chosen representatives were invited to be involved in drawing up care plans, which were reviewed regularly. It was clear from discussions with staff and residents that they have access to the health services they need. The home has an informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. Medicines were stored securely. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Comments received from residents and their relatives/visitors confirmed that staff treated them with respect and were supportive and kind. DS0000020474.V314524.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an adequate range of social opportunities available in the home, which reflects residents’ interests and preferences. There is a strong sense of homeliness and inclusion of family and friends in life at Kelso. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: Residents spoken with said that they were “free to make decisions about how they spent their days” and they were happy with the lifestyle that living at Kelso afforded them. Care records showed that each resident was helped to choose their daily routine. This included what time to get up in the morning and go to bed at night; whether the resident chose to stay in their room or go downstairs to the lounge; whether they liked to read, watch television or listen
DS0000020474.V314524.R01.S.doc Version 5.2 Page 13 to the radio. This was interspersed with a lot of cheerful interaction with staff, who spent time with each resident on a one to one basis as far as time would allow. Residents said that their visitors were always made welcome at the home and they could have visits in private and this was confirmed by visitors’ comments. Residents spoken with at the time of inspection said that they enjoyed the food provided. Three comment cards were received from residents and they all said they always enjoyed the food at Kelso. The menu offered choice and changes were made in accordance to residents’ wishes. DS0000020474.V314524.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with any complaints that might be made by residents. The home’s adult protection policy demonstrates an understanding of abuse and of how to protect residents from it. EVIDENCE: The residents spoken with during the inspection said that they would be able to talk to any of the staff about any concerns that they had and they would be taken seriously. No complaints had been raised since the last inspection with the home or the Commission for Social Care Inspection. The home had a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. DS0000020474.V314524.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within Kelso is good providing residents with an attractive, homely and safe place to live. The home is kept clean and smells pleasant thereby making daily life for all in the home more pleasurable. EVIDENCE: The home is well maintained both inside and out. The gardens are attractive, safe and easily accessible for residents. The building complies with the requirements of the local fire service and environmental health department. All areas of the home were clean and there were no unpleasant odours. Residents confirmed that the home was always clean and fresh.
DS0000020474.V314524.R01.S.doc Version 5.2 Page 16 The laundry was well managed and adequate supplies of clean linen were seen to be available. DS0000020474.V314524.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The deployment and number of available staff is sufficient to meet the needs of the residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are well trained and experienced and residents could be confident they would be well looked after. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. Residents said that they were grateful that the workforce at the home was permanent and many staff had worked at Kelso for a number of years. This meant that residents would receive the care they needed consistently. The home has an ongoing training programme, which includes NVQ level 2 in care. Approximately 50 of the care staff hold this award. Staff recruitment files were reviewed and they contained: • Completed application forms • Two written references
DS0000020474.V314524.R01.S.doc Version 5.2 Page 18 • • • • • Enhanced CRB checks Terms and conditions of employments Documentary evidence of any relevant qualifications Proof of identity A record of the interview Training files demonstrated that healthcare assistants were receiving induction training. Records showed that staff had received mandatory training such as manual handling, food safety, first aid, health and safety and fire safety training. Registered nurses spoken with during the inspection confirmed that they kept themselves professionally updated and attended relevant courses. This was always encouraged by the registered providers. DS0000020474.V314524.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by a committed and competent manager, who creates an open and positive atmosphere, which supports good care practices for residents. Although the views of residents and visitors has been sought the information gained has not yet been used to formulate an annual development plan. Residents are assured of sound management procedures, which protect their financial interests. The health and safety of the service users and staff are protected by the policies and procedures followed at Kelso. DS0000020474.V314524.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home is well managed by Mrs Ackrill, who is supported by a loyal and consistent staff. Residents and relatives said that she was very approachable and if they had any concerns they would be happy to talk to her knowing that they would be listened to. Mrs Ackrill is continuing to work towards a management qualification and anticipates finishing it within six months. Mrs Ackrill confirmed that she consulted with residents, visitors and staff about the quality of care and facilities at Kelso. Residents, relatives and staff confirmed that they were more than happy with the care and environment that Kelso provided. It was not only a good place to live/visit it was a good place to work. However Mrs Ackrill had not yet devised an annual development plan but confirmed it was her intention to continue to provide a good standard of care in a homely environment. The home does not handle residents’ personal finances. Residents are presented with bills for their fees and for any necessary expenses such as chiropody. Records showed that all staff had received recent training in fire safety and manual handling. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. DS0000020474.V314524.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 DS0000020474.V314524.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP31 Good Practice Recommendations Mrs Ackrill should complete the relevant management training within the conditions on the home’s registration certificate. The home should continue to evaluate its performance and produce an annual development plan as part of their quality assurance. 2. OP33 DS0000020474.V314524.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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