Inspection on 27/03/07 for Kelstone Court Nursing Home

This inspection was carried out on 27th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kelstone Court Nursing Home 04/06/08

Kelstone Court Nursing Home 05/12/07

Kelstone Court Nursing Home 13/11/06

Kelstone Court Nursing Home 08/12/05

Kelstone Court Nursing Home 30/06/05

Kelstone Court Nursing Home 06/01/05

Kelstone Court Nursing Home 28/07/04

Similar services:

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kelstone Court Nursing Home Cambourne Road Morden Surrey SM4 4JN Lead Inspector Liz O`Reilly Unannounced Inspection 27th March 2007 10:45 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 Kelstone Court Nursing Home DS0000060496.V334461.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. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kelstone Court Nursing Home Address Cambourne Road Morden Surrey SM4 4JN 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) 020 8542 0748 Yourcare Ltd Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th November 2006/February 2007 Brief Description of the Service: Kelstone Court is a registered care home with nursing providing accommodation and care for up to thirty residents. Twenty places are for older people who require nursing care. Ten places are for older people who require residential care. Accommodation is set over three floors with a passenger lift available for access. The home is a large purpose built property situated in a residential area of Morden in Surrey. The home is close to a group of local shops and a pub with Morden Park and Cannon Hill recreation grounds nearby. Public transport is easily accessed from the home and unrestricted parking is available in the local area. The home is owned by Yourcare Limited. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two regulation inspectors and included a visit to the home, discussions with residents and staff and examination of records. What the service does well: What has improved since the last inspection? Significant improvements have been made in a number of areas since the last inspection. Staff are consulting with individuals and their relatives on the care they provide. The care plans give more details of the needs and wishes of individuals and on the care provided. The care plans have been made much more individualised and contain good information about support needs. The extension to the ground floor is now open and provides additional space for residents. New furnishings have been provided giving the home a brighter look for residents. A large amount of staff training has been provided which assists in making sure that staff are developing their skills and knowledge. The staff response to complaints and comments has improved which allows for a more positive approach to improving the service. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 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 Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 23&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre admission assessments are carried out before anyone is admitted to the home. This makes sure that staff are aware of and can meet the needs of individuals. EVIDENCE: Pre admission assessments are in place for each person using the service. Staff use this information to set up an initial care plan for when the person moves into the home. This home does not provide intermediate care. We made two requirements at the time of the last inspection which the home still has time to complete. These were; that the home owners confirm in writing to the CSCI that they give residents full information on the fees they will be charged and that they confirm in writing to each person admitted that having seen or carried out the pre admission assessment the home can meet their individual needs. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Clear improvements have been made by staff in setting up care plans, consulting with representatives and recording health care needs. People who use the service have access to health care services. Staff are aware of the need to treat individuals with respect. Further action needs to be taken with the environment to ensure the privacy of individuals is maintained. EVIDENCE: Significant improvements have been made in the care planning and recording. Documents now give clearer information on the care planned, decisions made and the care delivered. Staff have also started to include some information on the social, emotional and cultural needs and wishes of individuals. Staff should take care to give details of the care to be provided. In one instance we found instructions for a person to be helped with leg exercises. This information needs to include who should do this, qualified or unqualified Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 10 staff, and what type of exercises. This will make sure that people who use the service are provided with the right care for them. Evidence was available to show that staff were consulting with people who use the service or their representatives on the individual care plans. In order to continue to develop care planning staff need to focus on person centred planning. It is recommended that senior staff are provided with training on person centred planning in order to lead the staff team. The wound care records are also much improved with clear information available on the treatment to be provided, the frequency of treatment and the progress being made. Staff are promoting the health of individuals with referrals being made to the tissue viability nurses, dieticians and other health care professionals. Regular visits are arranged for dental, optical and chiropody services. Medication was seen to be well managed with good records kept. Risk assessments are carried out and reviewed to make sure that individuals are provided with the appropriate equipment and treatment. Staff are monitoring and assessing pain which assists in ensuring that people who use the service are not suffering unnecessary pain. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities organiser provides a wide range of activities which take into account individual and group needs and wishes. Families are encouraged to maintain contact with their relatives and to be involved in outings. Further work needs to be done on menus and meal times to make sure that residents know what choices they have, what the meal will be and that they are provided with the food they like. EVIDENCE: Residents gave mixed feedback on how they feel about their daily lives. A number of residents were happy with the activities provided and enjoyed the regular trips out to places of interest and particularly to the local pub. The activities organiser provides a quiz every day for which is planned so that all residents can join in. Staff try to make sure there is at least one outing every month and relatives or friends are encouraged to take part in these. A variety of other activities are also provided including art and crafts, bingo, reading aloud of novels and poetry. Activities take place in small groups or on a one to one basis. Residents were also seen to be involved in their own interests and activities. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 12 The activities organiser attends the daily report twice a week which assists in communication between the staff. Comments on the activities from residents included, “I really enjoy going out to the pub”, “I like helping with the garden and feeding the birds”, “the quizzes are quite good”. Other residents told us that they felt “bored” and that there was “nothing going on”. This would suggest to us that further consideration should be given to tailoring activities to meet the needs of individuals and more of the staff team being involved in activities throughout the day. The menu for the day is on display but is written on a small board. When we spoke to residents about the lunch that day they did not know what they would be getting. It is recommended that information on what is on offer for each meal is provided in a clearer way. Residents told us that the food “is not too bad”, “is quite good” and “is well prepared”. Other residents said that “I don’t like the food”, “I don’t fancy the food” and “its probably chicken again”. Evidence that the home meets the cultural and religious needs and wishes of residents in relation to food must be available. In order to make mealtimes a more social event consideration should be given to more staff involvement. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure which is up to date. Complaints are recorded along with the actions taken. Residents are protected from abuse by the home having clear procedures and staff training on protection. EVIDENCE: Since the last inspection of the home we noted improvements in the approach of staff to dealing with complaints. A complaints procedure is in place but the home owners need to consider how they can make this more accessible to residents and visitors. The home has received one complaint since the last inspection which was dealt with promptly and recoded. All staff must be provided with clear guidance on complaints and effective communication. All staff have now received training on the protection of vulnerable adults. This training needs to be ongoing. Staff are provided with information on what they should do if they have concerns or allegations of abuse are made and these include informing the local social services and the CSCI. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 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. 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 home owners continue to make improvements to the environment. There are some areas of the home which are still in need of updating but a significant number of areas have been improved. Consideration needs to be given to how the communal areas are used now that the ground floor extension has been completed. We found the home to be clean and tidy. EVIDENCE: Since the last inspection the environment has been improved with the provision of new chairs, carpets, pictures and curtains in the lounge. The extension to the lounge is now open which provides additional space with tables and chairs so that some residents can take their meals at a table instead of sitting in the main lounge. This area also provides additional space for activities. The home owner said that a large screen TV would be provided in the dining area so that it could also be used for showing films. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 15 Part of the extension has been taken up as office space. We were told that this would be partitioned off and the space used reduced. Comments from residents on the environment were mostly positive. Residents were happy with their bedrooms, felt they were comfortable and well furnished. Bathrooms on the first and second floor are not fitted with locks. This needs to be addressed to make sure that privacy is protected. Generally bathrooms are in need of refurbishment and consideration should be given on how to make the bathrooms less clinical looking and more homely. One area which needs further consideration is the lounge and the placing of the televisions. This was the one part of the home which residents felt was not very comfortable. Residents said that the noise from the different televisions was disturbing. When we sat in the lounge we found that while watching one television we could only hear the commentary from another television on another channel. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A significant amount of training has been provided to staff in the last few months to make sure that residents are supported by a well informed staff group. This training must be continued to allow staff to further develop their skills. There are sufficient staff on duty to meet the needs of individuals. However consideration should be given to reviewing how the work is organised. Residents said that they felt safe with the staff. EVIDENCE: Residents made positive comments about the staff group and their approach. Staff were described as “very pleasant”, “very nice” and “very good”. The home owners have provided a significant amount of training for staff over the last few months to make sure that all staff have received up to date training. The progress made must be continued so that staff can further develop their knowledge and skills. Staff reported that they worked well as a team and that communication had improved over the last few months. Before any staff start work in the home checks are carried out including references and Criminal Records Bureau checks to help in protecting residents. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 17 Discussion with residents and observations we made indicated that staff need further guidance and or training on the importance of good communication with residents. Residents told us that staff worked very hard and so did not have much time to talk with them. We observed staff helping residents with little communication going on. The home has a keyworker system but this operates on a very basic level. Staff described the keyworker role as making sure that residents have enough toiletries and clothes and that their rooms are tidy. They keyworker role should be reviewed in line with providing person centred care. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 18 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. 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. Since the last inspection the home manager has left. Residents and their representatives are provided with questionnaires to check their satisfaction with the home. This needs to be further developed to include other people connected with the home and the results need to feed into an annual development plan. Staff make regular checks on and around the home to make sure the health and safety of residents, visitors and staff is protected. EVIDENCE: Since the last inspection of this home the manager has left. A new manager has been appointed but has not started work yet as pre employment checks have not been completed. We found the financial interests of residents were protected. Good records are maintained of any money held for a resident. In order to make sure that Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 19 records remain up to date it is recommended that individual records are checked and signed every two weeks. Resident and relatives meetings have been held in January and are planned for April. This will assist in ensuring that the views of people who use the service are listened to and action taken. The home owners have carried out resident and relative satisfaction surveys. In order to complete a comprehensive quality monitoring surveys need to include other professionals and visitors to the home. This information should be used to inform a development plan and annual review of the care provided. Health and safety checks are carried out with good records kept. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 20 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 2 3 X X N/A 3 X 2 X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? 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. 1. Standard OP2 Regulation 5A Requirement Confirmation that residents have been provided with the appropriate information on fees as set out in amended regulations from 1st September 2006 must be provided to the CSCI. The Registered Persons must make sure that they have confirmed in writing to the resident, that having seen or carried out the assessment the home can meet the needs of the person. Timescale for action 14/05/07 2. OP3 14 (1) (d) 14/05/07 3. OP15 16(2) 12(4) The Registered Persons must 17(2)Sch4 ensure a record of the choices made by residents at meal times is maintained. A menu which meets the cultural and or religious needs of individual residents must be provided. 01/06/07 Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 22 The Registered Person must carry out a review meal times, to include: Consultation with residents on the menu. The use of bibs How meals are presented The activities of staff during meal times. 4. OP16 22 All staff must be provided with 01/06/07 clear guidance on complaints and effective communication. The Registered Persons must ensure that appropriate locks which can be opened from the outside in an emergency are fitted to all bathrooms and toilets. The Registered Persons must ensure that an annual review of the quality of care is carried out taking into account the opinions of residents and any other stakeholders. A copy of the report produced following any review must be provided to the CSCI Timescale of 01/04/06 not met. 01/06/07 5. OP19 12(4)(a) 6. OP33 24 01/06/07 Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 23 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. 3. 4 Refer to Standard OP7 OP27 OP19 OP35 Good Practice Recommendations Staff should be provided with training on person centred care planning. A review of the role of the keyworker should be carried out. A review of the organisation of the lounge area should be carried out. Checks should be carried out on the money held in the home for residents on a fortnightly basis. Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Kelstone Court Nursing Home DS0000060496.V334461.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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