CARE HOMES FOR OLDER PEOPLE
Kelstone Court Nursing Home Cambourne Road Morden Surrey SM4 4JN Lead Inspector
Liz O`Reilly Unannounced Inspection 8th December 2005 10.00 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 Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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.V272352.R01.S.doc Version 5.0 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 Sarah Elizabeth Jackson 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.V272352.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th June 2005 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 provided 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.V272352.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 8th December 2005 over five and a half hours by two regulation inspectors. The inspectors had the opportunity to speak with nine residents four staff, the deputy and registered manager. A selection of records were also examined. What the service does well: What has improved since the last inspection?
Staff have worked to improve the consultation with residents and or their representatives about individual care plans. This ensures that all those concerned are aware of the way in which the home plans to meet the individual needs of residents. Work has started on consulting residents and others about how the home operates and whether the aims and objectives are being met and remain relevant. This needs to be continued.
Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 Page 6 The recording of medication has improved which assists in ensuring the health and welfare of residents. These improvements need to be continued. Staff have improved the information recorded on moving and handling equipment needed for individual residents. This ensures that all staff are aware of the needs of each person. 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. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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.V272352.R01.S.doc Version 5.0 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): 3&5 Assessments of the needs of each person are carried out before anyone moves into the home. Staff must ensure that an initial care plan is drawn up using the information provided on the pre admission assessment. Residents and or their relatives can visit the home prior to admission. EVIDENCE: If a resident is admitted via the local authority the home receives a copy of the care management assessment. In addition where possible staff from the home will also visit prospective residents to carry out their own assessment. To ensure that the needs of each person can be met from the time they are admitted to the home an initial care plan must be in place. The care plan should be drawn up using the information provided to the home from the pre admission assessments. Once a resident has been admitted then staff can further refine any initial care plan to suit the needs of the individual. Staff confirmed that prospective residents and or their representatives are encouraged to visit the home prior to making any decision to move in.
Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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, 8 & 9 Each resident is provided with a care plan which sets out individual needs and how these will be met. Improvements have been made in some areas of the care planning. Further work needs to be done to ensure that a full care plan is in place as soon as possible and that details of wound care are available. Staff must ensure that medication records are up to date. EVIDENCE: It was noted in one instance that the care planning documentation had not been fully completed for one person who had been in the home for over two weeks. As noted previously provisional care plans need to be in place prior to admission and further details must be sought as soon as possible. It is recommended that care plans are checked by senior staff at regular intervals particularly for new residents. Staff have improved the information available on any moving and handling equipment required for individuals. Progress has been made in consulting with residents and or their representatives on the content of the care plan. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 Page 10 All residents are registered with local GP surgeries. Arrangements are in place for residents to receive regular dental, optical and chiropody services. Residents are supported to attend hospital appointments. Staff consult with other health care professionals for advice on continence and wound care. The registered persons must ensure that staff are provided with clear information on the type and frequency of dressings to be used for any wound. Staff must carry out and record an evaluation of any wound at each dressing change. Evaluations must include the size and condition of the wound. The records relating to medication have improved however a number of instances were noted where medication had not been signed following administration. All staff must be reminded that medication must be signed for at the time of administration. It was also noted that instructions were in place for one resident to be supplied with pain killers prior to dressings being changed. These had not been given as instructed. All staff must be reminded that medication must be supplied as prescribed. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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, 14 & 15 Residents were complimentary on the activities available to them. Residents were very happy with the breakfast provided. Further work needs to be carried out on the menu. EVIDENCE: An activities organiser is employed in the home. A number of residents were seen to be involved in a quiz during this visit. The activities organiser spends time with each resident to find out their individual interests and wishes. Activities are provided in groups and on a one to one basis. Staff were found to be enthusiastic about supporting residents to go on trips in the local area and to spend evenings in the local pub. Families are invited to join in trips out and activities within the home should they so wish. Activities in the home include arts, crafts, gardening, crosswords, exercise sessions, debates and reading aloud of books and poetry. Residents made very positive comments on the activities and the approach of the activities organiser. A number of residents gave very positive comments on the breakfast provided. Breakfast was seen to be available throughout the morning to cater for those residents who do not wish to get up early. A cooked breakfast is available. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 Page 12 The menu does not give information on what alternatives are available at each meal time. Two residents stated that they liked the food but did not make their own choices and so did not know what they would be having at meal times. Two residents said they did not like the food provided and that the meals would not be what they would eat at home. One of these residents stated they would only eat part of the main meal. Later in the day the inspector noted that this person did only eat part of the meal. All other comments on the food were positive. The registered persons must ensure that information on what alternatives are available is clearly set out and provided to residents. A menu which meets the cultural and or religious needs of individual residents must be provided. Clear records of residents making their own choices regarding meals on a day to day basis must be available. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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): 16 & 18 Residents expressed confidence in the staff to deal with any concerns they may have. The home has a clear complaints procedure. Staff are provided with training on the protection of vulnerable adults which assists in protecting residents from abuse. EVIDENCE: The complaints procedure for the home was seen to be on display. This procedure includes clear timescales for the home to respond to any complaint. Systems are in place for all complaints to be recorded along with details of investigations and outcomes. Residents said they would approach the manager, other staff members or their family if they had any concerns or complaints. Staff are provided with training on the protection of vulnerable adults which ensures that staff are aware of their responsibilities should they have any suspicion or witness abuse of a resident. At the time of this visit all staff other than those who had recently joined the home had been provided with this training. The deputy manager was in the process of planning training for the new staff. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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): 19, 20 & 26 The home was found to be well maintained. Problems remain with the extension to the ground floor. Appropriate locks need to be fitted to all bathrooms to preserve the privacy of residents. Staff must ensure that residents have access to the call bell system when they are in their bedrooms. The home was found to be clean and tidy. EVIDENCE: Significant investment has been made to the building over the last two years. Recently a new passenger lift has been installed. Generally the building is well maintained. The communal area of the home is situated on the ground floor. This is one large room where residents watch TV, take part in activities and take their meals. There is insufficient space in this room to allow for more than one dining table so the majority of residents take their meals where they sit. Staff have made efforts to use the space effectively but the space restrictions leave
Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 Page 15 little opportunity for residents to meet with visitors in a quiet space or for residents to watch TV uninterrupted and comfortably. The home owners have commenced work on an extension which would provide more space for residents to eat meals, take part in activities or spend time away from television. However problems have arisen regarding the building work which have resulted in the work being stopped for some months. The registered persons should provide to the CSCI information on their plans for this building work to be completed or altered. It was noted that not all bathroom doors were fitted with locks. To ensure the privacy of residents appropriate locks, which can be opened by staff from the outside in the event of an emergency, must be fitted to all bathroom doors. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Sufficient appropriately qualified staff are on duty to meet the needs of residents. Staff are offered regular training opportunities. Further work needs to be done to ensure that the record of training, including induction, for each person is up to date. EVIDENCE: Two registered nurses are on duty at all times during the day with five care staff in the mornings and four carers in the evening. The registered manager and or the deputy manager are also on duty. At night one registered nurse and three carers are awake on the premises. The home also employs domestic and catering staff, an administrator and an activities organiser. Discussion with staff members indicated that they are provided with regular opportunities to take part in training both in house and externally. This ensures that residents are cared for by a well informed staff group. Further work needs to be done to make sure a clear record of the training completed and the training needs of each individual member of staff is in place. This will ensure that senior staff are aware of the individual training needs of each member of staff and the progress being made to meet these needs.
Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 Page 17 Residents gave positive comments on the approach of the staff group. Staff spoken to felt staff worked well as a team, that they had good training opportunities and felt valued by the management of the home. One member of staff compared Kelstone Court favourably with other homes they had worked in. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36 & 38 The home keeps a record of any money held on behalf of a resident. Staff are in the process of developing quality assurance and monitoring systems which will take into account the views of residents and others connected with the home. All staff must be provided with regular one to one supervision from a more senior member of staff. Staff carry out regular checks on the building and equipment to ensure the health and safety of residents. Further action must be taken in relation to checks on the fire alarm system and hot water temperatures. EVIDENCE: Residents can deposit small amounts of cash in the home for safekeeping. Staff keep a record of all money deposited and withdrawn. At the time of this visit staff were not receiving regular one to one supervision. To make sure that all staff are working in line with the homes’ aims and
Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 Page 19 objectives and to provide opportunities for individual staff development all staff must be provided with one to one supervision from a more senior member of staff at least six times a year. Staff are in the process of developing quality monitoring and assurance systems. Questionnaires for residents on how they feel the home is being run have been produced. Questionnaires for other people who visit the home have yet to be developed. An annual appraisal of the home taking into account the views of residents and other stakeholders needs to be carried out. A copy of the report following the appraisal must be supplied to the CSCI. Records showed regular checks being carried out on the building and equipment to ensure the health and safety of residents and visitors to the home. Staff must carry out weekly tests of the fire alarm system to ensure this is in good working order. The inspectors found that the hot water supplied to certain bathrooms was excessively hot. To ensure the safety of residents staff must check and record the temperature of bath water before any resident is assisted into the bath. Where the weekly testing of the hot water shows high temperatures a record of what action has been taken must be included as part of the records. Staff must ensure that denture cleaning tablets are stored safely. During the course of this visit the inspectors noted that fabric conditioner had been decanted into empty drinks bottles. Staff took immediate action to make sure that this practice was stopped. All staff must be made aware of the dangers of decanting liquids and appropriate containers must be sought from suppliers. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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 x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 1 x 2 Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 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 OP3 Regulation 15 12(1) Requirement The Registered Persons must ensure that a care plan is produced from the information provided by pre admission assessment and that a full care plan is produced without delay following admission to the home. The Registered Persons must ensure that the record of wound care includes the type and frequency of treatment. A wound evaluation must be carried out at each dressing change and recorded. The Registered Persons must ensure that the record of medication is signed for at the time of administration. The Registered Persons must ensure that all medication is administered as prescribed. The Registered Persons must ensure that residents are provided with clear information on the choices available at each meal time. A record of the choices made by residents must be maintained. A menu which meets the cultural
DS0000060496.V272352.R01.S.doc Timescale for action 24/02/06 2 OP8 17(1)(a) Sch 3 (k) 24/02/06 3 OP9 13(2) 01/02/06 4 5 OP9 OP15 13(2) 16(2) 12(4) 17(2) Sch4 01/02/06 24/02/06 Kelstone Court Nursing Home Version 5.0 Page 22 6 7 OP19 OP30 12(4) 23(1) 18(1)(c) 8 OP36 18(2) and or religious needs of individual residents must be provided. The Registered Persons must 24/02/06 ensure that appropriate locks are fitted to all bathroom doors. The Registered Persons must 01/04/06 ensure that a record of training completed and required is maintained for each member of staff including a record of any induction training. The Registered Persons must 01/04/06 ensure that all staff are provided with regular one to one supervision from a more senior member of staff. 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 The Registered Persons must ensure the following health and safety issues are addressed:1. Fire alarms must be checked on a weekly basis. 2. Hot water must be tested weekly and a record of actions taken retained. 3. The temperature of baths and showers must be checked before staff assist any resident into a bath or shower. A record of temperatures must be retained. 4. Staff must not decant any cleaning or laundry substances other than into containers provided by suppliers with appropriate labels.
DS0000060496.V272352.R01.S.doc 9 OP33 24 01/04/06 10 OP38 13(4) 01/02/06 Kelstone Court Nursing Home Version 5.0 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 Refer to Standard OP19 Good Practice Recommendations The Registered Persons should provide the CSCI with information on the plans for the completion or alteration of the work being carried out to extend the ground floor of the home. Kelstone Court Nursing Home DS0000060496.V272352.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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