CARE HOMES FOR OLDER PEOPLE
Kelso 10 Clifton Road Southbourne Bournemouth Dorset BH6 3PA Lead Inspector
Rosie Brown Unannounced Inspection 24th January 2006 11:15 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.V276413.R01.S.doc Version 5.1 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.V276413.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kelso Address 10 Clifton Road Southbourne Bournemouth Dorset BH6 3PA 01202 432655 01202 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.V276413.R01.S.doc Version 5.1 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. 17th November 2005 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: Mrs Ackrill has become the Registered Manager with the condition that she completes NVQ 4 management training within 18 months of registration as from April 2005. The staff team work closely with the Mrs Ackrill 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.V276413.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place on Tuesday 24th January 2006 at 11.15am. The inspection was the second of two statutory inspections carried out at Kelso nursing Home since 1st April 2005. This was the second time the inspector had visited the home, the inspection was positive and it was clear that this is a well managed home. Nine of the National Minimum Standards were reviewed during the visit as was the one requirement and two good practice recommendations set out in the last inspection report dated 17th November 2005. It is noteworthy that this report contains just two recommendations. Information was gathered through general observation, discussion with Mrs Ackrill, and the nurse in charge of the shift, one care assistant and one visitor. A tour of the premises and examination of the records available provided further information. On the day there were 10 residents accommodated in the home. Conversation with residents was limited due to their frailty but the inspector was able to have a meaningful discussion with one resident and talked generally with three other service users in the privacy of their rooms. What the service does well:
The home has a useful statement of purpose and guide, which is supplied to prospective residents or their representative prior to admission. Pre-admission assessments are undertaken before a resident is admitted into the home and careful consideration is given to how they will fit in with the current service user group. An initial plan of care is drawn up prior to admission to demonstrate that the home can meet resident’s nursing and care needs. Each resident has a plan of care that provides staff with guidance and instructions as to how their needs will be met and these are reviewed along with any care type risk-assessments on a monthly basis. Kelso provides residents with sensitive good quality nursing care, in a homely family style environment: their choices are promoted appropriately according to their physical ability and health constraints. DS0000020474.V276413.R01.S.doc Version 5.1 Page 6 Staff who work in the home are caring, friendly and helpful and committed to the training offered by the home: the staff team is stable and many staff have worked in the home for a number of years. The home’s recruitment procedures ensure that residents are protected from harm. The home is well-managed health & external professionals undertake safety checks, as are routine servicing checks of the equipment used in the home and the fire safety system. At the previous inspection 12 of the 15 National Minimum Standards assessed were met. During this inspection eight of the nine Standards were assessed as met. It is recommended that this report be read in conjunction with last inspection report in order to gain a full ‘picture’ of the home. 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.V276413.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000020474.V276413.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The home has a statement of purpose and guide and this is supplied to prospective service users and their representative on request. The information available enables the reader to make an informed choice about moving into the home. Standard 3 was assessed as met at the previous inspection. EVIDENCE: A copy of the homes statement of purpose and guide is available in the hallway of the home and is accompanied by a copy of the home’s latest inspection report. Mrs Ackrill has updated the statement of purpose to reflect that she became the registered manager in April 2005. The information supplied describes the home’s facilities and the services provided, particularly noting the holistic approach taken when providing care for an elderly frail group of people.
DS0000020474.V276413.R01.S.doc Version 5.1 Page 9 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 and 9 Each resident has a care plan that identifies the care being provided to meet identified needs. The home’s medication arrangements and practices are very good with trained nurses ensuring the safe handling and administration of resident’s medicines. Standards 8 and 10 were assessed as met at the previous inspection. EVIDENCE: The care plans and personal records for two residents were examined: this included one resident who had recently moved into the home. A pre-admission assessment was undertaken by Mrs Ackrill at a local hospital before one resident was accommodated in the home. I met this person in her shared room; she looked clean, comfortable and was relaxing in bed. The bed has rails fitted to ensure that they did not fall out of bed: records revealed there is a documented risk-assessment concerning the use of restrictive rails and gives the reasons why they are used. Records also evidence consultation
DS0000020474.V276413.R01.S.doc Version 5.1 Page 10 with other care professionals; although this person has late stage dementia their nursing needs are the main priority for this person. Records demonstrated that residents are unable to sign their own records their relatives sign on their behalf. A care plans for each person provided clear guidance for staff and determined how each identified need should be met. Staff were clearly familiar with residents’ needs and were observed to be patient and caring toward residents, the majority of residents are totally dependent on staff for assistance with personal care tasks. DS0000020474.V276413.R01.S.doc Version 5.1 Page 11 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 and 14 Residents are encouraged to maintain daily routines that are appropriate to their needs. The home strives to enable residents to make choices in their lives. Standards 13 and 15 were assessed as met at the previous inspection. EVIDENCE: One relative confirmed they regularly call into the home to visit and that they are always made to feel welcome by staff: they remain entirely happy with the way the home cares for their relative. Daily care notes demonstrated that where possible residents are helped to choose their daily routines, for example not staying in bed all day, being dressed and sitting in an armchair to watch TV or to eat lunch in their room. One resident confirmed they make choices about when they go to bed at night and get up in the morning and when they take a bath and said, staff are always here to help me when I need it’. They also confirmed that staff are approachable and kind.
DS0000020474.V276413.R01.S.doc Version 5.1 Page 12 Staff offer residents the opportunity to listen to music, play card games, have their hair done or their nails manicured. One resident takes communion in the home. Records evidenced the time spent with individual residents, for example one very frail resident who likes to listen to classical music but is completely immobile. Those residents who are more independent sit in the lounge at times and on warmer days spend time in the garden. DS0000020474.V276413.R01.S.doc Version 5.1 Page 13 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): 18 Residents are protected from abuse because the home has guidance available on the proper response to be made if any suspicion or allegation of abuse is made: staff have also been supplied with training in the identification of abuse and the local POVA guidance. Standard 16 was assessed as met at the previous inspection. EVIDENCE: The home keeps a copy of the local ‘No Secrets’ and a procedure to following regarding the identification of abuse and the appropriate response to allegations of abuse. There is also a copy of the POVA guidance kept in the staff room. Staff have signed to acknowledge they have read and understand both sets of guidance and other associated policies, eg ‘Whistle blowing’ and bullying in the workplace. All staff have undertaken training in the local ‘No Secrets’ procedures and the home’s induction programme and NVQ training incorporates training in the recognition and prevention of abuse. Notifications of untoward events are forwarded to the Commission as required and indicate that action ids taken to prevent recurrence. DS0000020474.V276413.R01.S.doc Version 5.1 Page 14 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): Standards 19 and 26 were assessed as met at the previous inspection. EVIDENCE: On the day of the inspection the communal areas and a selection of bedrooms were viewed. All areas were clean and in good order and a homely environment is created. DS0000020474.V276413.R01.S.doc Version 5.1 Page 15 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): 28 The home has a robust recruitment procedure and a staff training and supervision programme to ensure that residents’ are protected and that staff can meet their needs. Standards 27, 29 and 30 were assessed as met at the previous inspection. EVIDENCE: When the inspector arrived at the home a Registered General Nurse was on duty with one care assistant. I was informed that Mrs Ackrill was expected to be in the home that morning and she arrived shortly after me. The care assistant had responsibility for cooking lunch as well as care duties. The staff rota demonstrated there are always two staff on duty during the day and at night: one of these is an RGN. Mrs Ackrill said that she works as part of the staff team and this enables her to provide general practice supervision: one to one supervision is also supplied and this was confirmed by written records and by the staff on duty. During the previous inspection recruitment records evidenced that all necessary checks and information are obtained before staff commence working in the home: this includes the enhanced CRB check. Records also showed that new staff begin work under supervision and are subject to induction training that meets NTO specifications.
DS0000020474.V276413.R01.S.doc Version 5.1 Page 16 The home employs 10 RGNs and 7 care assistants. One care assistant has an NVQ 3 qualification while a further four have recently completed NVQ level 2 training in care. Two members of staff are NVQ Assessors and one is currently undertaking NVQ 3 training. DS0000020474.V276413.R01.S.doc Version 5.1 Page 17 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 and 35 The registered provider/manager, Mrs Ackrill is suitably experienced: she has yet to achieve an NVQ 4 management qualification. Residents’ finances are protected because the home bills each person for any transactions undertaken on their behalf. Standards 33 and 38 were assessed as met at the previous inspection. EVIDENCE: As stated in the previous report, Mrs Ackrill has relevant experience in residential care and has owned and managed Kelso with the assistance of senior nursing staff for almost 20 years. DS0000020474.V276413.R01.S.doc Version 5.1 Page 18 Mrs Ackrill became the home’s Registered Manager in April 2005 on condition that she achieves an NVQ level 4 management qualification within 18 months from the date of registration: she has commenced this training. Kelso is signed up to the Registered Nursing Home’s Association’s quality assurance policy, which makes a commitment to running the home in the best interests of it’s residents by responding to issues that may arise on a continuous basis. The home does not handle residents’ personal allowances or money. Mrs Ackrill explained that residents are presented with bills for their fees and for any necessary expenses, for example private chiropody. The home endeavours to keep expenses to a minimum, for example one resident needed new nightwear so they were given pyjamas as a Christmas present by the home. Four residents have solicitors who manage their personal finances while other residents have relatives who assist them with personal matters and financial commitments. DS0000020474.V276413.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X X DS0000020474.V276413.R01.S.doc Version 5.1 Page 20 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. 2. Refer to Standard OP9 OP31 Good Practice Recommendations When writing details of medicines onto MAR charts staff should ensure that all directions /details of prescribed medication are accurately transcribed. Mrs Ackrill should complete the relevant management training within the conditions on the home’s registration certificate. DS0000020474.V276413.R01.S.doc Version 5.1 Page 21 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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