Inspection on 23/07/08 for Kirkley Manor

This inspection was carried out on 23rd July 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

Kirkley Manor 24/07/07

Kirkley Manor 18/05/06

Kirkley Manor 20/10/05

Kirkley Manor 29/04/05

Kirkley Manor 21/10/04

Kirkley Manor 20/05/04

Kirkley Manor 19/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Kensington House Nursing and Residential Home 3 Kirkley Park Road Lowestoft Suffolk NR33 0LQ Lead Inspector John Goodship Unannounced Inspection 23rd July 2008 09:30 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 Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kensington House Nursing and Residential Home Address 3 Kirkley Park Road Lowestoft Suffolk NR33 0LQ 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) 01502 573054 01502 513862 adrienne@kingsleycarehomes.com Kingsley Care Homes Ltd Adrienne Conner Care Home 71 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (54), Physical disability (5) of places Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th July 2007 Brief Description of the Service: The home is registered for 71 service users in 51 single rooms and 10 shared rooms. Of these, 45 rooms have en-suite facilities. The home has grown up around the original large Edwardian house, and is set in well-tended grounds, to the front and rear. The provision of accommodation is suitable for older people with mobility problems, with appropriate aids and adaptations fitted, although the shaft lift is not modern - being fitted with a heavy, hand-operated outer door, and an internal iron grill cage door. Consequently, some service users may find this difficult to manage on their own. Kingswood unit is a newly built, self-contained dementia care unit that has been added to the rear of the home, and provides modern, comfortable accommodation for 17 persons with dementia. In addition, the main building can now accommodate persons with dementia, who require nursing care. The home is also registered to care for five people with physical disabilities aged between 50 and 65 years. At least one nurse is on duty at all times. There is a competent team of care staff, assisted by a full complement of ancillary workers. The home is operated by Kingsley Care Homes Ltd, which owns a number of other care homes in East Anglia. The Company Directors are regularly on the premises, as is the Operations Manager. The company also has a director of Quality and Compliance who provides support to the home. At the time of this inspection, the range of fees was £355.00 to £600.00 per week depending on needs and type of accommodation. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection visit was unannounced and took place on a weekday. It lasted eight and a quarter hours. It was undertaken by a regulation inspector, and an expert by experience. This is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The inspection focussed on the outcomes for residents, using discussions with senior staff, talking with residents and relatives, examining records, and touring the building. We spoke specifically to four residents, as well as chatting to others, to two relatives, and three staff. In addition, we had sent out a survey questionnaire to residents, relatives and staff. At the time of writing this report, we had access to three surveys back from relatives and one from a resident. Relevant comments have been included in this report. The manager was required to complete the Annual Quality Assurance Assessment, which allowed the home to describe what it does well, and how it plans to improve. Information from this document has been used in the report. What the service does well: The home provides a good standard of care in a comfortable and wellmaintained environment. The work of the staff is appreciated by residents and relatives: • ‘The staff seem so caring, cheerful, friendly and affectionate.’ • ‘They seem to achieve the difficult balance of allowing some independence with ensuring basic needs are met.’ • ‘The carers are very good at dealing with people’s different needs.’ A comprehensive quality assurance system is in place and there are a number of channels that enable the home to be aware of and respond to residents’ requirements. Complaints and concerns are responded to properly, and the home is knowledgeable about the local protection procedures. These systems help to protect and safeguard residents from abuse. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 6 Recruitment procedures are satisfactory, with staff properly inducted and trained. What has improved since the last inspection? What they could do better: No requirements have been made from this inspection. A number of recommendations about good practice have been made. There should be better recording of restraint consents, the reason for giving ‘as necessary’ medication, and any preference a resident may have about the gender of the carer performing personal care tasks with them. The temperatures of some rooms at the front of the building, and of the main dining room, should be monitored, as there have been comments about how cold and draughty they can be. Although the new boilers may help these problems, any further action should be taken as soon as possible. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 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 Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Standard 6 is not relevant to this home. Quality in this outcome area is good. People can expect to have access to the information they need to make an informed choice about the home, and to have the opportunity to visit the home before deciding whether to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We read the home’s Statement of Purpose and the Service Users’ Guide. Between them they covered all the items of information required by the Regulations to enable prospective residents to decide if they wish to live there. The accommodation was described together with the associated facilities. The training and qualifications of the management and the care staff were listed. The Statement set out what the fees covered, and what residents would normally pay for themselves. It said that fees would vary depending on needs and type of accommodation. In addition, the Service Users’ Guide gave details Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 10 of the care planning process and the ways in which residents could be involved in that process if they wished. It also said that residents had a choice of whether to take their meals in the dining room or in their room. The way in which a resident could raise a complaint was detailed, and the two documents had been updated in April 2008 to give the new address for the Commission for Social Care Inspection. The above documents informed residents that all new admissions had a sixweek period to decide ‘whether this is the place for you’. We were shown examples of contracts, which were signed by residents or their representatives, both those fully funded by a local authority, and those funded partly or wholly by themselves. The invoices we saw showed how charges had been calculated, as any extra personal items for residents were bought by the home and re-charged. During our visit, a member of the finance staff came down from the provider’s office on the top floor to assist a relative with a financial matter. The deputy manager said that they would always ask the finance officer to meet any relative or resident who had queries about aspects of their invoices. Three residents’ files were inspected, including one who had been admitted since the last inspection. All three contained pre-admission assessments, two of them incorporated a social care single assessment, and the third incorporated a hospital discharge record. The assessments covered all areas of care and daily living, and could be followed up in the care plans produced upon admission. The deputy manager told us that potential residents were offered a trial visit when they may attend lunch and participate in activities, but few were able to take up this opportunity. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. Residents can expect staff to identify and review their care needs to ensure appropriate care is given. Their safety is protected by the home’s medication procedure and medication audits. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We inspected three care plans. They were comprehensive, with a photograph of each person and the plans for all the residents had been reviewed on a monthly basis. Reviews were signed and dated. One plan contained an ‘Agreement to the care plan’, signed by the next of kin. The AQAA told us that the home would be trying to involve relatives more in the preparation and reviews of care plans. One record had a pressure chart with a body map, again updated within the previous month. Mobility assessments were described by the ‘traffic light’ Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 12 system of colours for ready identification by staff. All plans contained falls risk assessment, observation of vital signs (weight, blood pressure, pulse rate and temperature), and a social needs assessment. After one falls assessment, the decision had been taken to use bed rails for one resident. There was clear guidance for staff on the safe use of these, but no evidence that the resident or their relative had formally consented. We spoke to this resident but they were not able to remember how the use of bedrails had been introduced. Where relevant, there were risk assessments of personal safety, the eyesight of a diabetic, and communication needs. On the recommendation of the community nurse, a behaviour chart had been kept continuously for one week for one resident to help assess their behavioural needs. This had led to the GP reviewing their medication. Daily notes seen for three residents were completed in a professional way and were informative and non-judgemental. The lead nurse told us that the policy was that an entry must be made at least once every 24 hours unless the resident’s condition required more frequent entries. We saw an example of this in one record. Records contained details of visits from GPs, chiropodists, and opticians. One resident whose care plan we saw told us that ‘I haven’t seen a doctor’. When we reported this to the nurse, she explained that their GP had visited several times but had not yet been able to relieve their symptoms. The care plan recorded these visits. We spoke to two visiting relatives who told us that their family member received excellent care. In particular, they appreciated how well staff knew how to deal with the aggressive behaviour outbursts of this person. Another relative told us that the staff were always friendly and ‘seem genuinely affectionate and fond of my (relative). Sometimes I feel I need more information from the staff about my (relative’s) health and attitude. They do give me this information if I seek it out.’ We observed staff being attentive and patient with residents, and showing sensitivity to their needs, for example over the choice of lunch dishes. One shared room did not have a curtain or curtain rail to separate the two beds and allow privacy. The deputy manager took action to rectify this at once. A relative wrote in the survey: ‘My relative has Alzheimers and is completely paralysed. The staff always make sure X is left comfortable and turned every two hours.’ ‘I am always kept informed by phone of any issues, such as a fall or a change to his care. When I visit, the nurse in charge always informs me of any changes.’ Another told us: ‘I always check the bed and it is always very clean.’ We observed the lunchtime medication round in the Kingswood unit, which was undertaken by a nurse. The nurse followed good procedures in administering the medication, which was in a monitored dosage system. Medication was individually popped into small containers to take to residents. Each time the Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 13 medication trolley was left it was locked. The nurse checked if residents needed a glass of water, and waited with each resident until they had taken their medication. Medications were signed for as they were given, and the nurse advised that after they had completed the round they would go through and check the records. The sample of medication administration records (MAR) we examined contained no gaps in signatures. Where the resident had been prescribed a drug PRN (as required) the reason for giving it was recorded. All records had a photo of each resident for confirmation of identification. We noted that the medication for one of the residents in the nursing area whose care plan we inspected had been changed at the last GP review to include Haloperidol twice a day and PRN. This followed the week’s behaviour record referred to above. The MAR chart showed that the drug had been given at the correct times, and once as PRN. There was no indication of the time of day this latter had been given or the reason for it. We inspected the drug room for the main unit. It was a small area under the stairs and although secure did not allow much room for staff to work in. A delivery of new drugs had just arrived so the drug trolley could not be put into the room until these had been put away. During this time the trolley was locked but not chained to the wall, although it was within the area of the nurses station. The Controlled Drugs cupboard met the regulations. The records for two residents were examined. There was the correct amount of each drug in stock, and the record of usage tallied with this figure. The drug fridge had a temperature indicator which was checked and recorded daily. The figures were within the safe limits. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. Residents can expect social activities to be well-managed, and provide daily variation and interest. Relatives and friends are made welcome. Menus provide good nutrition and residents are supported to eat meals at their own pace. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The major improvement that had taken place since the last inspection was the appointment of a full time Activities Co-ordinator, resulting in a great benefit to the residents with a wider range of activities and more attention paid to individual needs and interests. The deputy manager and the co-ordinator were very enthusiastic about the levels of social activity that they had promoted to improve the quality of life of the residents. There was something provided every afternoon, such as quizzes, bingo, sing- along, musical entertainment, and exercises. During our visit, an entertainer with a keyboard was playing to residents in one of the lounges. Several residents had been brought from other parts of the home so the room was full. Everyone appeared to be enjoying it, with many joining in with the songs. Considerable thought had been given to Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 15 the creation of a cinema, and Friday evenings were devoted to the showing of vintage films with the addition of choc–ices, all of which contributed to a feeling of ‘occasion’ and frequently promoted reminiscences and discussion. There was a ‘Sensory’ room which concentrated on an atmosphere of quiet and calm, equipped with a central rotating ceiling strobe light, very comfortable furnishings and a slow moving film could be projected onto one wall, accompanied by soothing music. Any resident who was feeling agitated or upset could go and spend time in this room, and we were told that it had proved particularly helpful to those suffering from dementia. Outings were arranged by the co-ordinator, who took groups out into nearby Kensington Gardens, where they could sit and have a cup of tea from the café, and three residents told us that they were going to the Air Display the next day, and were obviously looking forward to it. One resident told us that should they want to go back to the block of flats where they previously lived, to see old friends who still lived there, the co-ordinator would readily arrange this and make it possible. We were told that the one gap in the outings programme was the fact that the residents in wheelchairs were not able to participate because of the difficulty of accessing a suitable vehicle. The menu ran on a four-week cycle. It was displayed on notice boards and included a choice of main dish. But we asked some residents waiting for lunch if they knew what was on that day and they did not know. However staff did ask them at the table which dish they would like. The deputy manager showed us how far she had got with producing a picture menu album to help residents make their choice. In the main dining room, there were tablecloths on the tables, vases with a flower, drinks, condiments and cutlery. The menus showed that there were always two options and one vegetarian dish available. Supper was a hot snack, or sandwiches with a dessert. One resident told us that they had had a good breakfast. ‘The breakfast is always good.’ Another resident said: ‘The food is 101 . You would never starve here.’ We noted that extra staff had been employed as waitresses to assist with the serving of the meals, allowing care staff more time to support residents. We joined the residents in the main dining room for lunch. The meal was tasty, hot and well presented. We noted that one resident kept falling asleep during the meal. The staff were very attentive to this person, checking several times whether they wanted to eat more of their meal. The home had plenty of communal space and there were quiet areas where residents could choose to sit. In the two larger lounges, we noted that the television was always on. It was not clear how many residents were able or wanted to watch it. One resident had told us in the survey that ‘the TV is on all the time.’ There were other sitting areas without TVs. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 16 The deputy manager told us that one of the residents who was blind had the audio version of Sky which described what was happening on the screen. Two surveys, one from a resident and one from a relative, suggested that staff should wear name badges. The resident wrote: ‘It would really help me if the staff wore name badges to tell me who they are and what they do.’ The deputy manager told us that this had been brought up in residents’ meetings and in the home’s last satisfaction survey, and the management were likely to agree to implement this change. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. Residents can expect to have good access to formal and informal routes of raising complaints and for them to be listened to, taken seriously, and acted on. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had an appropriate complaints procedure in place, which was included in the Statement of Purpose and the Service Users’ Guide. The AQAA told us that the home had received six complaints in the last year. None of them had been upheld. The complaint log listed complaints under a format which recorded the action taken to investigate the complaint, and how it was resolved to the satisfaction of the complainant. The deputy manager told us of a recent incident when staff had incorrectly opened an envelope addressed to a resident. It had been resealed and given to the resident with an apology. The Commission for Social Care Inspection was copied into the correspondence of a complaint about care practices. This showed how the home investigated the concerns in detail. A relative suggested in their survey that it would be a good idea to put a book next to the visitors’ book in the hall for comments, concerns and suggestions. We passed this idea to the deputy manager who said they would implement it. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 18 A relative told us that they visited twice a week and any concerns they had were dealt with while they were there. The home had recently referred two incidents to the Adult Safeguarding Team. One concerned the way a resident’s finances were being managed by a third party. Although the home had no responsibility for this, the family had raised the matter with the home. It was soon found that everything was in order. The second was raised by the home after an allegation of poor handling of a resident. Two staff were immediately suspended and then final written warnings were issued. Further training and supervision were implemented. We examined the policy on the protection of vulnerable adults (POVA) which was up-to-date and in line with the Suffolk Adult Safeguarding Board (ASB) procedures. We recommended that the policy should make it clear that no investigations should take place until sanctioned by the ASB after referral. Staff files showed that no staff were employed until POVA checks were received, and training records showed that all staff attended refresher training on protection procedures and abuse recognition once a year. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,25,26. Quality in this outcome area is good. Residents and relatives can be assured that the home provides a comfortable and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We noted areas of the home that had been freshly decorated with clean and bright walls. The newly painted areas did show up the duller and drabber areas including corridor carpets. During our visit however the maintenance manager was able to tell us that the directors had approved the replacement of these carpets and those in the dining room with vinyl, to improve the appearance, hygiene and easier movement of residents in wheelchairs and hoists. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 20 There were no signs or pictures on the individual room doors of those residents with dementia in the nursing unit; the environment on the nursing unit had not been significantly modified to cater for the needs of residents with dementia, other than by the provision of security measures. The rooms did have large numbers on them that were easy to read, but impersonal. The deputy manager told us that the walls of the corridors in the Kingswood unit had been repainted so that there was a different colour on each floor. At least when leaving the lift, residents would know it was their floor. Two new boilers had recently been installed which the maintenance manager hoped would give more control of heating in the home. At the same time thermostatic valves had been fitted to all radiators. We had been told that the dining room could be cold in the morning, and that some rooms were draughty. A resident wrote in their survey: ‘My room is freezing when it’s windy.’ Although this survey was anonymous, the maintenance manager believed it could refer to some of the rooms at the front of the building, particularly those with metal window frames not yet double-glazed. In two bedrooms, wall heaters had been installed to improve the temperature. Conversely, we noted that the Kingswood unit was extremely warm. Staff told us that the number of windows made it difficult to control the temperature. It was a very sunny day when we visited. However, staff told us that some residents were susceptible to the cold and the temperature suited them. This was confirmed to us by one resident who did not think it was too warm. We saw that building work was going on at the rear of the home. We were told that the work was to build up this area to improve the access for residents, and to create a sensory garden area. The housekeeper explained to us the arrangements for cleaning and for the laundry. They told us that staff were trained to cover all areas of work to make it easier to cover any absences. All rooms were cleaned daily and eight to ten were deep cleaned each month. She identified four rooms which were becoming increasingly difficult to keep clean and hygienic. One room was scheduled to have the carpet replaced, and the others might end up the same way. A relative told us: ‘The two cleaners responsible for X’s bedroom leave it very fresh and clean. The window is always left ajar to let in fresh air while the room is empty.’ The laundry used three washing machines and three dryers, and was staffed by a laundry assistant. The housekeeper said there was a continuing problem with unnamed personal clothing. She had a big pile which could not be traced back to their owners. She was about to write to all families to ask them to ensure all items of clothing were marked, and to check next time they visited to see if they could re-unite clothes with their owner. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 21 The lead nurse had overall responsibility for infection control. They attended a three monthly update at the local hospital. An alcohol hand gel dispenser was placed next to the signing in book for visitors. Others were distributed around the home. The lead nurse told us that these should only be used as an extra precaution by staff as the policy required them to use hand washing as the principal control measure. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. Residents are cared for by well-trained staff, whose care and concern is appreciated by residents and relatives. Residents can expect that they will be protected by the home’s policy on recruitment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the staffing roster, and compared it with the number staff on duty during our visit. There were nine care staff and two qualified nurses on duty on the early shift, with six carers and one nurse on the late shift. At night there were three carers and one nurse on duty. The total numbers had been increased since the last inspection to take account of the increased dependency of the residents. From the total on duty during the day, three staff were allocated to the Kingswood unit. Extra staff had been employed as waitresses in the main dining room, to assist with the serving of the meals, allowing care staff more time to support residents. The home employed a full time activities coordinator in addition to these care staff. We interviewed a senior and a junior member of staff. Both agreed that there were sufficient staff on duty to provide support to all the residents. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 23 We examined the home’s annual training plan which showed that all care staff received training in the mandatory topics each year. These included moving and handling, cross-infection, fire procedures, health and safety, protection of vulnerable adults, hazardous substances and food hygiene awareness. The dates when these would be due next year were also set out. Some staff also attended First Aid training with three yearly updates. Documents and certificates in staff files confirmed that these courses had been attended. Eight staff who administered medication had received update training in June 2008, and six senior staff had completed training in Dementia Care in 2006 and 2007. The deputy manager showed us details of the Skills For Care knowledge set on dementia care, which the home would be using from now on. Twenty-one staff had completed NVQ Level 2 training, and seven staff were studying for it. Some non-care staff were included in these numbers. Nursing staff had undertaken specialist training in male catheterisation, syringe drivers and tracheostomy care. Six senior staff in all departments had received inhouse Team Leader training in the last twelve months. The care staff included seven males. A relative had commented that one resident did not like to be assisted by a male carer in the shower. We interviewed a male carer who stressed to us that the wishes of a resident would always be respected. None of the care plans we sampled indicated any preference by those residents. We recommended that such preferences should be recorded. We examined two staff files. Both contained full application forms, identification documents, two references, and photo ID. Both had a Criminal Records Bureau Certificate. Training records were also in their files. Over half the care staff were of East European origin. Comments had been made at previous inspections by some residents and relatives about the difficulty of communicating because of the level of English spoken, and the accent. The staff whom we spoke to had a reasonable level of English although some words had to be repeated because of the accent. No comments were made to us this time about communication. One resident told us: ‘I get on very well with the staff. They hug me and make a lot of fuss of me.’ A relative told us: ‘There are many Polish workers but the staff all work together very well. Most of all they are very good with the residents.’ Another relative told us: ‘My relative says how lovely the Polish girls are.’ Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38. Quality in this outcome area is good. Residents can be assured that there is a system for obtaining their views on the running of the home to ensure it is run in their best interests. A process of staff supervision protects residents by continually monitoring and improving the skills of the staff. The system of auditing, and the regular maintenance checks, ensure that the home is safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had been registered with the Commission for Social Care Inspection in October 2007. The updated Certificate of Registration was displayed in the hall. The manager is a qualified nurse and holds the Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 25 Registered Managers Award and the NVQ Level 4 in Management. The manager was supported by a deputy and a lead Nurse. The provider operated a comprehensive quality assurance system. Monthly visits were made by a director and their report met the requirement of Regulation 26 of the Care Standards Act. Regular quality monitoring visits were made by the Director of Compliance and Quality Assurance. Following comments from the 2007 residents’ survey, the home had started regular residents’ meetings. These were chaired by the activities organiser. This person told us that they would make a point of trying to seek the views of those residents unwilling or unable to attend these meetings. One change arising from these meetings had been the introduction of a tea trolley with a selection of biscuits and cakes for residents to choose. Previously only biscuits were offered. We saw residents making their selection during the visit. The residents’ survey for 2008 had been issued and most returns were in but not yet analysed. The deputy manager told us that the issue of staff name badges had been raised this time and would be considered. The home produced a quality report each year detailing what they had done and what they would do in respect of relatives’ and residents’ suggestions and comments elicited from questionnaires. The home’s policy on the holding of residents’ monies had changed since we last inspected. No monies were now held for residents. Any costs they incurred for eg hairdressing, and personal requisites, were bought by the home and invoiced to the person responsible for fee payments on a monthly basis. We saw the records of staff supervision sessions. The schedule showed that these took place on a two monthly basis. Annual appraisals were also undertaken. Staff meetings were held by department. We inspected the records of health and safety checks such as fire alarm tests, hot water checks, and emergency lighting. The home’s Fire Risk Assessment was in date and due to be reviewed in August 2008. We also saw servicing contracts for lifting equipment and for the lifts. A relative had queried the safety of the oldest lift in the main building. This had been serviced in January 2008 and the contractor had identified no concerns. Accident records were up-to-date and fully completed. They were audited as part of the provider’s quality policy and analysed by name, by type of accident and by type of injury if any. There were obvious trends in the analyses we saw. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 X X X X 3 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 3 X 3 X 3 3 3 3 Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP8 OP9 OP10 OP18 OP25 Good Practice Recommendations The positive consent of the resident or their representative to the use of bed rails should be recorded. Where any medication is prescribed PRN, the time and reason for its administration should be recorded. The home should record the preference of a resident for a particular gender of carer for personal care tasks. The home’s POVA policy should make clear that no internal investigations should proceed until authorised by the adult safeguarding team. The temperatures of front bedrooms and the dining room should be monitored, and action taken to improve the heating where necessary. Kensington House Nursing and Residential Home DS0000040035.V368802.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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