CARE HOMES FOR OLDER PEOPLE
Kenroyal Nursing Home 6 Oxford Street Wellingborough Northampton NN8 4JD Lead Inspector
Stephanie Vaughan Unannounced 20 June 2005 10:00 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 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 C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Kenroyal Nursing Home Address 6 Oxford Street Wellingborough Northants NN8 4JD 01933 277921 01933 277781 None Mr Mukesh Patel Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Saila Bala Das Care Home 34 Category(ies) of OP Old Age (34) registration, with number of places Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The home should be registered to accommodate 34 service users in the category of OP for either personal care or nursing care. Date of last inspection 27/10/04 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 is currently seeking 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 C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was conducted over a period of five and a half 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 four residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. Three 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, the service history, the Pre Inspection Questionnaire and comment cards received from residents and their representatives. Ten comment cards were received from residents all indicated general satisfaction with the service provided, however five of these indicated that the home only sometimes provided suitable activities. Thirteen comment cards were received from residents’ representatives, nine of these indicated satisfaction with the service provided and a further three expressed a high level of satisfaction. One response indicated some dissatisfaction regarding the level of care, supervision of residents, hygiene and maintenance within the home. The comments received were taken into account during the conduct of the inspection and are addressed within the body of the report. What the service does well:
The home provides good information about the services and facilities available to residents. This is made available to residents and their representatives’ prior to admission to enable them to decide whether the home can meet their individual needs and expectations. Residents are fully assessed prior to admission in order that the home can be sure that they are able to meet the residents’ needs and expectations. Individual plans of care demonstrated that all aspects of health, personal and social care needs of residents are addressed, providing detailed instruction to
Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 6 staff on how that care is to be delivered. Daily records, observations, discussion with residents and staff confirmed that care is delivered according to the information specified within the plan. Privacy and dignity are managed well within the home; residents confirmed this and said that the staff were nice. Staff relate well to residents and are respectful. Routines are flexible and residents are able to maintain links with family and friends. Residents have access to a varied menu with alternatives that provide a balanced diet. Residents confirmed satisfaction with the food provided. The home has an appropriate complaints policy, residents and their representatives are aware of the process and feel able to express any concerns. Residents feel safe living at the home and training has been provided for some staff regarding the Protection Of Vulnerable Adults. Staffing levels, recruitment practices and staff training ensure the health and safety of residents. Residents are supported to manage their finances, the home ensures that money is stored appropriately and accurate records are maintained. Safe working practices are evident within the home What has improved since the last inspection?
The premises are now in need of redecoration and refurbishment however the Registered Provider is currently planning a major extension to the premises, which will also include refurbishment of the existing facilities. A recommendation was made as a result of previous inspections for the home to be assessed by a qualified occupational therapist regarding the provision of aids and adaptations. This has now been done and a report provided, there is evidence that the recommendations made by the occupational therapist are being addressed. Staffing within the home appears to be adequate and a Registered Nurse covers each shift. Current levels include 5 staff during the daytime hours and three waking staff at night. In addition the care team are supported by administration, maintenance, domestic, laundry and catering staff. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 7 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. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 standard(s) 1 & 3 Admission processes at Kenroyal Nursing home are good and enable residents and their representatives to decide whether the home is able to met their needs and expectations. EVIDENCE: The home provides up to date and appropriate information to residents and their representatives regarding the services and facilities at Kenroyal Nursing Home. Copies of this information were also available in the main entrance. Individual plans of care evidenced that residents receive a full assessment prior to admission by a senior member of the staff to ensure that the home is able to meet the needs and expectations of prospective residents. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 standard(s) 7, 8 & 10 Residents are supported to maintain their health, privacy and dignity, however access and referrals to a Registered Dietician should be improved. EVIDENCE: Individual plans of care are developed from preadmission assessments conducted by the home and other professionals. Care plans demonstrated that all aspects of health, personal and social care needs of residents are addressed, providing detailed instruction to staff on how that care is to be delivered. Daily records, observations, discussion with residents and staff confirmed that care is delivered according to the information specified within the plan. Individual plans of care evidenced appropriate risk assessments, frequent review and the involvement of either the resident or their representative. Residents are supported to maintain their health and there was evidence that the health of residents improved following admission with weight gain and the healing of pressure sores. All residents have appropriate assessments for the risk of falls, pressure, movement and handling and nutrition. However
Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 11 although residents have access to a range of medical and specialist services there was no evidence of guidance for staff regarding special diets or individual referral to a registered dietician where a particular need had been identified. Privacy and dignity is managed well at the home and the Service User Guide sets out the principles in the aims and objectives and the Residents Charter includes the statement ‘This is the residents home, we are the visitors’ Staff were seen to relate well to residents referring to them in their preferred form of address as specified within the care plan. In addition staff were seen to knock on the doors of residents private accommodation and await permission prior to entering. Residents spoken to confirmed that staff were nice and that they were able to receive their chosen visitors in the privacy of their own rooms if they wished to do so Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 & 15 Daily life is managed well at Kenroyal Nursing Home. However residents should be further informed about the range of communal activities available, to enable them to make informed choices regarding the activities programme EVIDENCE: The home has a dedicated activities co coordinator and a timetable of communal activities is displayed in the hallway. This was seen to evidence bingo sessions five mornings a week, with television and DVD’s of old films on some afternoons and evenings. The Registered Manager confirmed that the residents are consulted regarding the content of the timetable of communal activities. However five of the comment cards received from residents indicated that the home only some times provides suitable activities. Other specified activities include a monthly visit from a visiting entertainment group. In addition the Service Users Guide indicated that other activities are available such as cards, scrabble, bingo, draughts and ball games and a range of outings. Individual plans of care evidenced that the activities co coordinator meets with residents individually to discuss their interests and to plan personal activities specific to their expressed interest
Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 13 Residents spoken to confirmed that they were able to maintain contact with family and friends, that visiting times were flexible and that they were able to receive their chosen visitors in private. Individual rooms evidenced personalisation and care plans evidenced access to external agents and personal records. The lunchtime service was viewed and seen to comprise braised steak, with an alternatives of sausages, served with mashed potatoes and vegetables. Dessert comprised homemade pineapple upside down cake and custard. The menus were prominently displayed and seen to offer a seasonal rolling menu with further alternatives of salad and fish. Meals appeared well presented, of adequate proportion and to offer a balanced diet. Residents spoken to confirmed satisfaction with the food provided at the home. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 standard(s) Residents and their representatives are able to express any concerns that they may have and residents are protected from abuse. EVIDENCE: The home have received no complaints within the last twelve months, Comments cards received from residents and their representatives indicated that they knew who to talk to if they had any concerns and access to the homes complaints policy. The complaints policy is included within the Statement of Purpose and provides appropriate information. Residents spoken to confirmed that they felt safe at the home. Staff spoken to confirmed access to the Local Authority Guidelines and were able to demonstrate an understanding of the issues associated with the protection of vulnerable adults. Training in the Protection Of Vulnerable Adults has commenced with six staff have received formal training. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 standard(s) 19,22 &26 The planned improvements will enable residents to enjoy a more pleasing environment. Hygiene and infection control practices must be improved. 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. However the premises are now in need of redecoration and refurbishment. There was evidence that individual rooms are redecorated as they become vacant and arrangements were being made to replace the carpeting in all the residents’ rooms for the week following the inspection. Some outstanding issues were identified such as loose and missing handles to the fitted wardrobes and a missing fitting to one of the washbasins and these were addressed during the inspection. Some of the freestanding furnishings and en suite bathing facilities are in need of replacement. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 16 However the Registered provider is currently planning a major extension to the premises, which will also include refurbishment of the existing facilities. The project is due to commence in August, subject to planning permission. A recommendation was made as a result of previous inspections for the home to be assessed by a qualified occupational therapist regarding the provision of aids and adaptations. This has now been done and a report provided, there is evidence that the recommendations made by the occupational therapist are being addressed. In the main the home is clean and hygienic, however there are areas where this is not the case. These include areas not easily accessible such as ceilings and high fittings in addition to areas of heavy communal usage such as corridors and the lift. The Registered Persons confirmed access to fulltime domestic support, although the hours worked are not currently recorded on the duty rota. One of the resident’s rooms had an unpleasant odour and examination of the bed linen identified a stained sheet that should have been changed by the staff earlier in the day. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Staffing levels, recruitment practices and staff training ensure the health and safety of residents. EVIDENCE: Staffing within the home appears to be adequate and based on the guidance issued by the Residential Forum and a Registered Nurse covers each shift. Current levels include 5 staff during the daytime hours and three waking staff at night. In addition the care team are supported by administration, maintenance, domestic, laundry and catering staff. Residents and staff confirmed that staffing levels were generally satisfactory and able to meet the needs of residents. This view is supported by twelve of the comment cards received from residents’ representatives. Staff files evidenced sound recruitment processes with appropriate documentation including references and Criminal Record Bureau Clearances. Staff files evidenced access to appropriate induction training and National Vocational Qualifications. In addition staff have access to a range of mandatory training and training specific to the needs of the residents. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 & 38 Management systems are generally managed well however the annual quality assurance surveys should be further developed and staff supervision should be introduced. EVIDENCE: The home conducts an annual quality assurance survey to seek the views of resident’s and their representatives. Examples of these completed forms were available for inspection and provided positive feedback and indicated where improvements might be made. However the results are not systematically collated and published. Residents are supported to manage their finances, the home ensures that money is stored appropriately and accurate records are maintained. A spot check was conducted and seen to correspond with the balance and receipts of the resident’s expenditure were retained.
Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 19 Staff files evidenced annual appraisal however there was no evidence of formal staff supervision and this was confirmed by both management and staff spoken to. Staff have access to mandatory training such as food hygiene, first aid, fire safety, movement and handling and infection control training. A recent Fire Officer’s report was available for inspection purposes and this was satisfactory, with no requirements of recommendations. The kitchen is well maintained and appropriate food hygiene practices are in place and comprehensive records are maintained. The hot water temperature was checked and found to be tepid in various locations throughout the home. Further investigation identified that the heating system had been turned off due to the current hot weather and the hot water had also been turned off in error. However this was rectified during the inspection. Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x 3 x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 2 x 3 Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 21 No 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. 2. Standard 26 26 Regulation 23 (2) (d) 13 ( 3 & 4 ) 12 (1 & ) Requirement All parts of the home must be kept clean Soiled bed linnen must be removed and replaced with clean linnen. Timescale for action 01/08/05 01/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 8 8 & 15 12 Good Practice Recommendations Referral to a Registered Dietician should be sought through the General Practioner for residents with an identified risk Staff with responsibility for the provision of special diets should have access to guidance from a Registered Dietician. The arrangements for consultation with residents regarding the choice of communal activities should be reviewed to ensure that the programme meets the needs and wishes of all residents. Quality assurance systems should be further developed to include the collation of results and feedback to prospective and existing residents and their representatives A system of formal staff supervision should be intorduced and staff superviswed 6 times a year. 4. 5. 33 36 Kenroyal Nursing Home C51 C08 S12621 Kenroyal V233542 200605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 1ST Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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