CARE HOMES FOR OLDER PEOPLE
Kenroyal Nursing Home 6 Oxford Street Wellingborough Northants NN8 4JD Lead Inspector
Stephanie Vaughan Unannounced Inspection 14th November 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 Kenroyal Nursing Home DS0000012621.V265518.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. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kenroyal Nursing Home Address 6 Oxford Street Wellingborough Northants NN8 4JD 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) 01933 277921 01933 277781 Mr Mukesh Patel Mrs Saila Bala Das Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home should be registered to accommodate 34 service users in the category of OP for either personal care or nursing care. 20/06/05 Date of last inspection Brief Description of the Service: This home is situated on a major route in the town of Wellingborough. It is privately owned and the Registered Provider is not based on site. The home’s organisational structure includes a manager and an administrator with responsibility for running the home on a daily basis.Nursing care is provided to service users over 65 years of age. The majority of rooms are singles with en suite facilities. Communal areas comprise 2 lounges and a dining room.The building can be described as refurbished Victorian, and there are maintained grounds. The Registered Provider has obtianed planning permission for a major extension which will enable the home to accomodate thirty two more residents within a dedicated Dementia Care Unit. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced statutory inspection was conducted over a period of four hours during which the inspector made observations and spoke to several residents. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of two residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. Several members of staff were spoken to and a selection of staff files were viewed. Prior to the inspection a period of 60 minutes was spent in preparation, which included a review of previous inspection reports, previous requirements and recommendations and the service history. What the service does well:
Admission processes at Kenroyal Nursing home are good and enable residents to decide whether the home is able to meet their needs and expectations. Individual plans of care contain detailed instruction to staff about how health, personal and social care is to be delivered. Daily records indicated that the care is delivered according to the individual plans of care. Individual plans of care and other documentation demonstrate that pressure ulcers are managed well and that external specialist advice is sought appropriately Residents spoken to confirmed that their privacy and dignity is respected by the staff, that visiting was flexible, that they were able to bring in personal possessions and make choices about their daily lives. The lunchtime service was viewed and residents commented freely on their enjoyment food the food provided. Food appeared well presented, of adequate proportion and choice. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 6 Residents spoken to confirmed that they felt safe at the home, that the staff were very nice to them and that they would feel able to raise any concerns that they might have. What has improved since the last inspection? What they could do better:
Staff files evidenced sound recruitment processes with appropriate documentation including references and Criminal Record Bureau Clearances.
Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 7 However although the audit sheet contained in one file had been ticked to show that the Criminal Records Bureau Clearances had been obtained there was no record of the reference number, the date that it had been obtained or signature of the staff who had checked it. Appropriate risk assessments are in place however the risk assessments for the use of bed rails must be reviewed. Currently these cover the consent for use by the resident or their representative and record a professional judgement made by a senior nurse as to the need for the bed rails. However there is no reference to a formal assessment to include the risk of entrapment, use of protectors, suitability of the rails for the type of bed, maintenance, training and observations that should be made to ensure the safety of residents 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. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Admission processes at Kenroyal Nursing home are good and enable residents to decide whether the home is able to meet their needs and expectations. EVIDENCE: Residents spoken to confirmed that they were satisfied with the homes admission procedures and that they had had an opportunity to visit the home prior to deciding whether the home was able to meet their needs and expectations. Individual plans of care evidenced a preadmission assessment which had been conducted by the home and copies of assessments conducted by the placing authorities. Standard six is not applicable, as the home does not cater for intermediate care. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 & 10 Residents are supported to maintain their health, privacy and dignity EVIDENCE: Individual plans of care are generated from the pre admission assessments; these evidenced regular review and residents or their representative’s involvement. Individual plans of care contained detailed instruction to staff about how health, personal and social care is to be delivered. Daily records indicated that the care is delivered according to the individual plans of care. In addition individual plans of care also evidenced risk assessments for the prevention of falls, pressure, nutrition, movement and handling. Following recommendations made at the last inspection residents assessed as having a nutritional risk have been referred to a dietician which has resulted in improved health and well being. In addition the home have also provided training for key staff in nutrition. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 11 Individual plans of care and other documentation demonstrate that pressure ulcers are managed well and that external specialist advice is sought appropriately. Residents spoken to confirmed that their privacy and dignity is respected by the staff and staff were seen to relate well to residents. Individual plans of care evidenced that residents are consulted about their wish to have privacy locks fitted to their private accommodation. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Daily life is managed well at Kenroyal Nursing Home to meets the needs and expectations of residents EVIDENCE: Following a recommendation made at the last inspection the Registered Manager confirmed that residents have been consulted about the activities programme. This was evidenced in the form of minutes taken at a subsequent residents meeting and confirmed satisfaction with the existing scheduled arrangements. Individual plans of care evidenced that the activities coordinator continues to see residents individually to plan and provide personalised activity. The home also organizes seasonal functions and most recently held a bonfire night party to which residents were able to invite their relatives and friends. Residents spoken to confirmed that visiting was flexible, that they were able to bring in personal possessions and make choices about their daily lives. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 13 The lunchtime service was viewed and residents commented freely on their enjoyment food the food provided. Food appeared well presented, of adequate proportion and choice. Residents are assisted appropriately and the dining room provides a congenial setting. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Residents and their representatives are able to express any concerns that they may have and residents are protected from abuse. EVIDENCE: The Commission for Social Care Inspection have received no complaints about the home and an appropriate complaints policy is included within the Statement of Purpose, which continues to be accessible to residents and their representatives. Residents spoken to confirmed that they felt safe at the home, that the staff were very nice to them and that they would feel able to raise any concerns that they might have. Staff spoken to were able to confirm recent training in the Protection Of Vulnerable Adults and demonstrate their awareness of the procedures identified within the Local Authority Guidelines. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The standard of the environment has been improved and meets the needs of residents EVIDENCE: A limited tour of the premises was conducted and seen to be generally suitable for the needs of residents with adequate provision of private accommodation and communal areas. Residents confirmed satisfaction with their environment regarding both the communal areas and their private accommodation. The home have recently obtained planning permission for an extension to the premises, which will also include refurbishment of the existing facilities in the near future. However the home have replaced many of the carpets in the existing building and following a requirement made at the last inspection improvements have been made to the standard of hygiene and fittings within the home.
Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 16 The Registered Manager confirmed that she now routinely walks the premises to monitor the standard of hygiene and maintenance. A further requirement was made at the last inspection for soiled bed linen to be removed and replaced. The Registered Manager confirmed that a new supply of bed linen had been obtained and that staff were now directed to ensure that all residents have their bed linen replaced each day or more frequently if required. Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Staffing levels, recruitment practices and staff training continue to ensure the health and safety of residents EVIDENCE: Staffing levels continue to be maintained at an adequate level, based on the calculated dependency levels of residents. With the provision of 5 staff during the daytime hours and three waking staff at night. All shifts include at least one Registered Nurse. In addition the care team are supported by administration, maintenance, domestic, laundry and catering staff. Staff files evidenced sound recruitment processes with appropriate documentation including references and Criminal Record Bureau Clearances. However although the audit sheet contained in one file had been ticked to show that the Criminal Records Bureau Clearances had been obtained there was no record of the reference number, outcome, date that it had been obtained or signature of the member of staff who had checked it. Staff spoken to confirmed that the home provides access to appropriate training, such as induction, National Vocational Qualifications, fire safety, movement and handling, health and safety, food hygiene, infection control and first aid. Kenroyal Nursing Home DS0000012621.V265518.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, 36 & 38 Management processes have been improved, however further improvement is required to ensure the health and safety of residents requiring the use of bed rails EVIDENCE: Following a recommendation made at the last inspection quality insurance systems have been improved to ensure that the results are collated and residents are given feed back. The results are used to influence service developments and are displayed on the notice board in the main entrance. Following a recommendation made at the last inspection staff supervision has been commenced and continues on a regular basis. Staff have access to mandatory training and accidents are recorded appropriately.
Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 19 Appropriate risk assessments are in place however the risk assessments for the use of bed rails must be reviewed. Currently these cover the consent for use by the resident or their representative and record a professional judgement made by a senior nurse as to the need for the bed rails. However there is no reference to a formal assessment, based on the guidance issued by the Medicines and Healthcare Products Regulator. (www.mhra) to include the risk of entrapment, use of protectors, suitability of the rails for the type of bed and mattress, maintenance, staff training and observations that must be made to ensure the safety of residents. Kenroyal Nursing Home DS0000012621.V265518.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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x 3 x 2 Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 21 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 OP29 Regulation 19 Requirement Staff files must evidence that Criminal Records Bureau Clearances have been obtained i.e. date reference number, outcome and signature of the Registered Manager Risk assessments for the use of bed rails must be reviewed and based on the guidance issued by the Medical and Healthcare Products Regulator, to ensure the health and safety of residents. Timescale for action 01/12/05 2 OP38 13 (4) 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kenroyal Nursing Home DS0000012621.V265518.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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