Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 19/12/05 for Kenilworth Nursing Home

Also see our care home review for Kenilworth Nursing Home for more information

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a clear service user focus that is helped by the staff having a detailed knowledge of all the service users and their needs. There is good communication between staff, service users and relatives, which contributes to the smooth running of the home. Staff and service users appeared to have positive relationships with each other. The atmosphere in the home on the day of the inspection was relaxed and friendly. The home is fully staffed and is clean throughout.

What has improved since the last inspection?

The administrators reported that some redecoration of parts of the home had taken place, and some furniture had been replaced. The recommendation made in the previous inspection report that Adult Protection should become a standing item at staff meetings seems to have been implemented. The recommendation that the Fire Service be invited to inspect current fire prevention measures in the home has been followed up and the visit has taken place (see below).

What the care home could do better:

The Fire Officer recommended the home to undertake a revised fire risk assessment for the home. The administrators were not able to locate this document, either it still needs to be done, or if has been completed, it must be made available to staff within the home. The regulations concerning the return to a pharmacist of unused medication by care homes have recently changed. The nursing staff on duty were not aware of the changes and were not able to produce any documentation concerning such returns that have taken place. Senior nursing staff need to be briefed on such matters so that they can take the appropriate action if the registered manager is not present. The Inspector noted that none of the bathroom doors and toilet doors used by service users had locks. Although this policy is designed to safeguard a service user who may be unable to unlock the door to get out, the policy is at outs with the need to protect the privacy and dignity of all service users and it must be changed. Toilet and bathroom doors must be lockable, but the locks may be of the type that can be opened in an emergency by a member of staff from the outside. To safeguard service users, it may be necessary to fit additional call bell points within toilets and bathrooms. Some furniture and equipment in communal areas must be replaced, ventilation must be improved in the smokers` lounge and it is recommended that the television in this lounge is connected to an external aerial or source in order to improve the quality of life for service users. The furniture provided in service user`s bedrooms does not in all cases fully meet the minimum standard required.

CARE HOMES FOR OLDER PEOPLE Kenilworth Nursing Home 26/28 Kenilworth Road Ealing London W5 3UH Lead Inspector Robert Bond Unannounced Inspection 19th 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 Kenilworth Nursing Home DS0000010949.V268887.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. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kenilworth Nursing Home Address 26/28 Kenilworth Road Ealing London W5 3UH 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 8567 1414 020 8567 1052 Mr and Mrs Gopaul Mr Coossialsing Gopaul Care Home 40 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (0), Old age, not falling within any other category (0) Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 elderly mentally infirm 40 adults over the age of 40 with dementia Date of last inspection 15th August 2005 Brief Description of the Service: Kenilworth Nursing Home is a 40 bedded Care Home giving care to service users within the category of Mental Health. The home, which is situated in a quiet residential area in Ealing, is sited in two formerly detached two storey houses, which have been joined into one building. Rooms are sited on three levels with a lift connecting the floors. The home has 15 double rooms and 10 single rooms. There are several communal areas, which vary in size and are all utilised by service users. There is also a garden area that, when the weather allows, service users can use. The home is 10 minutes walk from Ealing Broadway, where there is a shopping centre and access to bus, tube and rail transport facilities. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector met with and was shown around the home by two nieces of the proprietor who work as administrators in the home. The proprietor who is also the registered manager of the home was on holiday for a week. The Inspector also met with senior nursing staff, domestic and care staff, and talked to several service users all of whom expressed their satisfaction at living in the home. The Inspector also examined various records, policies and procedures, and looked at in detail (case-tracked) the care file of one service user chosen at random. The administrators reported that the home had currently three service users vacancies, but that the home was fully staffed. This was the second of two unannounced inspections this year and the emphasis was placed upon assessing the performance of the home against certain of the key standards of the Government’s National Minimum Standards (NMS) for care homes for older people. The Inspector assessed 17 of the Standards and concluded that 10 were fully met, whilst 7 were partly met. The Inspector made 7 requirements and 2 recommendations. What the service does well: What has improved since the last inspection? The administrators reported that some redecoration of parts of the home had taken place, and some furniture had been replaced. The recommendation made in the previous inspection report that Adult Protection should become a standing item at staff meetings seems to have been implemented. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 6 The recommendation that the Fire Service be invited to inspect current fire prevention measures in the home has been followed up and the visit has taken place (see below). 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. Kenilworth Nursing Home DS0000010949.V268887.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 Kenilworth Nursing Home DS0000010949.V268887.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): These outcomes and standards were not assessed on this occasion but the outcomes for NMS 4 to 6 were all fully met at the last inspection. EVIDENCE: Kenilworth Nursing Home DS0000010949.V268887.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, and 10 The outcomes for NMS 7 and 8 are fully met. The outcomes for NMS 9 and 10 are only partly met for the reasons stated below. EVIDENCE: NMS 7 and 8: The Inspector examined in detail (case-tracked) the care plan and care file for one service user chosen at random. The records were seen to be appropriate and in order. NMS9: The Inspector examined the storage of medication in the home, and the records of medication administered. These were in order. The Inspector asked to see the home’s records of unused medication that the home had returned to the pharmacist. The home’s senior nursing staff were unable to produce any records and they reported that this was always dealt with by the registered manager. The senior nursing staff were not aware of the details of the changed regulations for the return of medication by care homes that provide nursing. See Requirements 1 and 2. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 10 NMS10: The Inspector noted that bathrooms and toilets used by service users were not fitted with locks. This is contrary to NMS10 which says that service user’s privacy and dignity must be respected at all times. There are ways of promoting the safety of service users whilst they are alone in toilets and bathrooms that does not involve leaving the door unlocked. These methods include staff remaining nearby to listen for any call for help, installing additional call bells, and fitting locks that can be opened from the outside in case of need. See Requirement 3. Kenilworth Nursing Home DS0000010949.V268887.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): The outcomes for these standards were not assessed at this inspection but all were considered to be fully met at the previous inspection. EVIDENCE: Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 12 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 and 18 Both outcomes are fully met. EVIDENCE: NMS16: According to the administrators, no complaints have been received by the home in the period since the last inspection. NMS18: The Inspector examined the minutes of the last staff meeting and noted that ‘whistle-blowing’ by staff had been an item on the agenda. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 13 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, 21, 24, 25 and 26 The outcomes for NMS19, 20, 24 and 25 are not fully met for the reasons stated below. The outcome for NMS 21 is not fully met as lavatories without locks are not suitable. The outcome for NMS 26 is met. EVIDENCE: The Inspector toured the home in the company of an administrator and at times a senior nurse. The design of the home is fit for purpose, the rooms are of sufficient size, adequately decorated, heated and lit. The premises were found to be clean and hygienic throughout. However there are a number of minor issues that mean that certain environmental outcomes for service users are not fully met. NMS25: The smokers’ lounge was very smoky, so much so that the patio door had been opened despite in being a cold day. The Inspector was concerned that as a result the temperature of the room had fallen to an unacceptably low level. The staff on duty were not able to produce a room thermometer to measure the temperature. See Recommendation 1. The smokers lounge must Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 14 be provided with adequate ventilation (such as an electric extractor fan) so that recourse does not have to be made to opening the patio door on a cold day. See Requirement 4. NMS19 and NMS20: Television reception in the smokers’ lounge was poor because the set did not have an external aerial, and the internal aerial had fallen behind the set. The staff on duty did not seem to have noticed. Radio reception in the non-smokers’ lounge was poor because the set’s aerial was broken. The radio cassette machine was damaged and could no longer play cassette tapes. Several items of furniture in the non-smokers’ lounge were damaged. Hence furniture and equipment in communal areas must be maintained in good condition and working order or replaced. See Requirement 5 and Recommendation 2. NMS24: The Inspector was shown into three service users’ bedrooms. He noted that in the two double rooms seen, there was only one lockable cabinet, not one per service user. In the single room visited, the lock on the cabinet was missing. The rooms seen did not contain a table to sit at, as required by NMS 24.2. See Requirements 6 and 7. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 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): 27, 28 29 and 30 The outcomes are all fully met EVIDENCE: The administrators reported that the home is currently fully staffed. The Inspector examined the current staff rota. Sufficient staff were seen to be on duty on the day of the inspection. The Inspector checked recruitment records that demonstrated that all appropriate checks were being undertaken. The Inspector checked training records that were also in order. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 16 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): The outcome for NMS 38 is fully met. The other outcomes in this section were not assessed at this inspection, but at the previous inspection NMS 32, 33 and 35 were all found to be fully met. EVIDENCE: NMS 38: The Inspector checked hot water, fridge and freezer temperature records and found them all to be in order. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 17 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 2 x x 2 2 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 x x x x x x x 3 Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 18 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. 1. Standard OP9 Regulation 13 (2) The registered person shall make suitable arrangements for the disposal of surplus medication received into the care home. The registered person must ensure that persons employed in the care home receive training appropriate to the work they are to perform The registered person shall make arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users (by fitting suitable locks on toilet and bathroom doors) Improved ventilation must be installed in the smokers’ lounge. All equipment used in care homes must be kept in good working order. All furniture must be kept clean and in good repair or be replaced. All service users are required to have a lockable cabinet or box within their bedroom. All bedrooms are required to contain a table to sit at. DS0000010949.V268887.R01.S.doc Requirement Timescale for action 01/02/06 2. OP9 18 (1) © 01/02/06 3 OP21OP10 12 (4) (a) 01/02/06 4 5 OP25 OP19 23 (2) (p) 23 (2) © 01/02/06 01/02/06 6 7 OP24 OP24 23 (2) (m) 23 (2)(f) 01/03/06 01/03/06 Kenilworth Nursing Home Version 5.0 Page 19 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 OP25 OP19 Good Practice Recommendations All lounge areas should have a thermometer on the wall. The television in the smokers’ lounge should be connected to an external aerial, satellite dish or cable network. Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 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 Kenilworth Nursing Home DS0000010949.V268887.R01.S.doc Version 5.0 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!