CARE HOMES FOR OLDER PEOPLE
Kenton Hall Nursing Home Kenton Lane Gosforth Newcastle upon Tyne NE3 3EE Lead Inspector
Irene Bowater Unannounced 8 July 2005 09:00 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. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Kenton Hall Nursing Home Address Kenton Lane Gosforth Newcastle upon Tyne NE3 3EE 0191 271 1313 N/A N/A Solehawk Ltd 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) Vacant CRH 60 Category(ies) of OP Old age (60) registration, with number of places Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13th December 2004 Brief Description of the Service: Kenton Hall Care Home provides nursing care for up to 60 older people.The home is purpose built and shares the site with the residential home owned by the same company. The home has two floors which are accessible by stairs and a passenger lift. Both floors have large separate dining rooms and a range of lounges including a separate smoking room. There is a large conservatory on the ground floor which leads into a large pleasant garden. There are specialist bathrooms,showers and toilets available on both floors. All of the bedrooms are single and have en-suite facilities. There is easy access for wheelchair users and ample car parking. The home is located within a residential area,close to all local amenities and is accessible by local transport. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 5.5 hours. There has been no registered manager for some time, however the deputy manager was available and assisted throughout the inspection. Part of the day was spent in the office and the majority of the time was spent touring the home and spending time with the residents, staff and visitors. Thirteen staff, ten residents, 4 relatives and 3 visiting professional were spoken to throughout the day. What the service does well:
The home receives detailed assessments from care managers before ant resident moves into the home. The senior staff also visit potential residents in their own home or in hospital and complete an admission record of all residents needs. These records then provide the basis of the residents care plan and ensure the staff can meet residents’ needs. There is a stable core staff team who have worked at the home for some time and they are keen to raise standards and try to give consistent care for each resident. Residents said they are well looked after and they get everything they need. Comments included “I want for nothing,” “I am treated well”, and “I am treated like royalty”. Relatives were also very positive about the care and all other services and comments that “The staff are outstanding, nothing is too much trouble and they are caring and professional”. The staff ensure that the residents have access to all healthcare professionals and they seek other professionals advice when necessary. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 6 There is a four week varied menu offering choices and variety. Special diets are catered for and the staff ensure all residents are provided with a variety of snacks and drinks throughout the day. Residents and relatives said the “meals are good”, and we enjoy the food”. Residents said they felt safe living in the home and knew how to complain if they were unhappy about anything. Relatives said that they were satisfied that all concerns would be dealt with well. What has improved since the last inspection? What they could do better:
There are some outstanding requirements from the last inspection, which now must be resolved to ensure the home remains safe and free from infection. The conservatory would benefit from new furniture, and ornaments to make it
Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 7 more homely. Other issues which need to be actioned are Repair the shower room and wall tiles Replace light cords to allow daily cleaning Replace the bedpan holder Ensure that fire training and fire risk assessments are completed and up dated The recruitment of a manager must be progressed Senior management must implement a monthly report for the home and inform the Commission of any issues 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. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 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 Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 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) 1,3,4, The Statement of Purpose and Service User Guide provides residents and prospective residents with details of the services the home offers to provide enabling an informed decision about admission to the home. The admission procedures are comprehensive and ensure the staff can meet residents assessed needs. The staff team have the skills and experience to deliver the care including nursing care the home offers to provide. EVIDENCE: The Statement of Purpose has been changed to ensure potential residents and their representatives have all the information they need regarding the home before deciding to live there. A sample of the care plans showed that the home receives a comprehensive assessment from care managers prior to residents moving into the home. Residents also receive a nursing assessment and an assessment from senior
Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 10 nursing staff in the home to ensure residents needs’ can be met. Since the last inspection the staff have received both statutory and specialist training to ensure residents needs are met. Currently the dependency and skills of the staff are taken into account when staffing the home. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10, There is a clear approach to the care planning system, which ensures the staff have the required information to deliver the care residents need. The health needs of residents are met with evidence of multi disciplinary working taking place on a regular basis. The staff have a good understanding of the residents support needs and endeavour to promote their rights to privacy and dignity at all times. EVIDENCE: There has been a vast improvement in all aspects of care planning and record keeping within the home. The care plans inspected were clear, detailed up to date and followed a recognised nursing model. The plans are regularly reviewed and updated to reflect residents changing needs. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 12 Risk assessments are available and there is evidence of six monthly reviews taking place with residents and their representatives. Two visiting nurses said that the care planning documentation had improved and they were able to follow the care provided. Residents have access to all NHS facilities. A range of pressure relieving equipment is available and in use. The wound care records are comprehensive and advice from tissue viability specialist nurses is sought when necessary. The care plans show that advice from speech therapists, continence advisors, and dieticians is sought and acted upon as necessary. Records of residents weights are recorded and any weight gain or loss recorded and appropriate action taken. It was evident throughout the inspection that the staff have formed good relationships with the residents who live in the home. They were observed using the residents preferred name and ensured all personal care took place in the privacy of residents’ own rooms, bathrooms and toilets. Relatives said that the staff were professional, friendly and showed both themselves and their relative the greatest respect and always ensured their relative’s dignity was preserved. Three residents said “I am treated like royalty”, “I am treated well” and “I am well looked after”. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 13 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) 13,15 The staff endeavour to support residents to maintain links with the communities far as they are able to do so. Dietary needs of residents are catered for with a balanced and varied selection of food available that meets residents, taste, choice and specialist needs. EVIDENCE: The home encourages relatives and all other representatives to continue visiting and keep in contact with their relatives. There were several visitors to the home and they all said that they are always made welcome, can visit at any time and use the various communal areas or visit in the privacy of their relative’s bedroom. Links with the local community are maintained as far as possible and as individual residents wish. A resident’s family were staying with their relative and said, “nothing is a bother, all the family are welcomed and also cared for.” There has been a tremendous improvement to how the meal times are organised since the last inspection.
Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 14 Residents were enjoying a leisurely breakfast at 9am either in the dining rooms or in their own rooms. Lunchtime was also an unhurried pleasant time with residents having a choice of main course and dessert. Residents said the food had improved in the home and they had no complaints. The dining rooms were pleasantly decorated and the tables appropriately set for each meal. Two relatives said they currently have all their meals in the home and thought the standard of the meals was good. The kitchen was clean and organised. Records were available to show that all fridge, freezer, and cooked food temperatures are maintained. There was an ample supply of fresh, frozen, tinned and dried food, which was appropriately stored. Residents are offered drinks and snacks throughout the day. Each afternoon fresh fruit is offered with a variety of drinks and fortified drinks are given to residents who have a low body weight. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 15 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) 16,18 The complaints process with in the home is currently satisfactory. The staff have knowledge and understanding of Adult Protection issues, which protect residents from harm. EVIDENCE: The home has a complaints policy and procedure, which is readily available in the home. Relatives and visitors said they knew how and to whom to complain should they wish to do so. The complaints records are satisfactory and there have been no complaints since the last inspection. Since the last inspection the policies and procedures for dealing with suspected abuse are now readily available in the home. Staff were able to discuss the steps they would take should there be any allegation or suspicion of abuse. Protection of Vulnerable Adults training continues. Currently 19 staff have completed the training programme. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 16 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) 19,20,21,26 The standard of decoration within the home is satisfactory, providing the residents with a comfortable, homely place to live. There are a few hygiene matters, which could place residents at risk. EVIDENCE: The location and layout of the home is suitable for the residents who live there. The accommodation is over two floors, which are accessed by stairs and a passenger lift. A large garden is accessed through a large conservatory. The pond area has been landscaped and fencing has been erected to prevent slips and falls around this area. There is a redecoration programme and there is evidence of redecoration in bedrooms and some communal areas. The home has a variety of lounges, dining rooms and separate smoking rooms
Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 17 on each floor. All areas were clean, nicely decorated and domestic in style. The conservatory is large, however there is only a small amount of furniture in the room making it look unwelcoming. The conservatory is not used in the colder months, as there is no heating. All of the bedrooms have an en suite facility. There are specialist bathrooms, showers and toilets close to all resident’s rooms and communal areas. There was a stale odour from one shower upstairs and the tiles were loose and broken. The sluices are located separately and are kept locked when not in use. On the day of inspection the home was clean, tidy well maintained and odour free. All of the home including bedrooms are cleaned on a daily basis. Liquid soap and paper towels are now provided in all resident areas to enable to the staff to wash their hands effectively. Several of the light cords were grubby and could not be cleaned on a daily basis. The plastic covering on the bedpan holder was split, corroded and also could not be cleaned on a daily basis. The laundry was clean and organised on the day of inspection. The home has an infection control “link nurse” who ensures staff follow infection control procedures. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 18 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 The home is adequately staffed with qualified nurses and care staff to meet the residents assessed needs. The recruitment and selection procedures ensure that residents are protected from harm. The arrangements for induction and ongoing training are satisfactory with staff being trained and competent to care for the residents. EVIDENCE: The home has been without a Registered Manager for some considerable time. Currently the deputy manager and senior nurse have been allocated supernumerary hours for the day-to-day management of the home. Advertising for a suitable manager is in progress. The difficulties with recruiting care staff and qualified nurses have been resolved. Agency staff are only used in an emergency situation. The staffing levels are: 3 qualified nurses during the day: 2 qualified nurses overnight. 9 carers during the day; 4 carers overnight. Ancillary staff consists of an administrator, domestics, laundresses, chef, kitchen assistants and maintenance person. The home currently does not have
Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 19 an activities organiser. Given the dependency levels of the residents in the home the home reviews the staffing levels on a regular basis to ensure the assessed needs of residents is met. A sample of the personal files found evidence of Criminal Record Bureau checks, suitable references, proof if identity and qualified nurses have their Personal Identity Number checked with the Nursing and Midwifery Council to ensure they are registered to practice. There has been an improvement in the staff training since the last inspection. There is an induction and foundation programme for new staff. All staff have received training in moving and handling, health and safety, first aid, infection control, dementia care, wound care, and Protection of Vulnerable Adults. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 20 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) 31,32,35,38 Despite there being no Registered Manager being in post for some considerable time the senior staff have showed good management and leadership through out the home with all staff demonstrating an awareness of their roles and responsibilities. The detailed procedures, which are in place, protect resident’s financial interests. The lapse in some statutory training and records do not promote or safeguard the health, safety and welfare of residents, staff and visitors. EVIDENCE: The home has been without a Registered Manager for some considerable time. The deputy manager and senior nurse have been allocated supernumerary hours to ensure the day-to-day management of the home.
Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 21 Recruitment of a suitable experienced manager is currently in progress. During the absence of a Registered manager the senior staff communicated a clear sense of direction and leadership to the staff, which has improved the care, and all aspects of the service for the residents. The monthly management report for the home has not been made available to the Commission for Social Care Inspection. All of the staff spoken to said how happy they were and how they now worked as a team. They also said that they receive good support, and they feel that their opinions matter. The detailed accounting systems are still in place. Records are available for all transactions and receipts cross reference to residents’ individual accounts. The home is progressing with statutory training. Fire training is planned, however the training has not been carried out four times a year for night staff and twice a year for day staff. There is a fire risk assessment, which has not been updated for 2005. Accident reporting is appropriately documented. Contract maintenance certificates were available and up to date. Water temperatures are monitored and recorded weekly. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 22 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 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 2 2 x x x x 2 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 Standard No 16 17 18 Score 3 x 3 1 2 x x 3 x x 2 Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 23 YES 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 OP 21 OP 26 Regulation 23 13 Requirement The home must resolve to odour problem in the shower room and repair the loose broken tiles. The home must clean and replace dirty light cords to enable easy cleaning. OUTSTANDING SINCE 13/12/04 The home must relpace the bedpan rack in the sluice. The home must progress with the recruitment of a suitable manager. The home must supply a copy of the unannounced visit report to the Commision for Social Care Inspection. The home must ensure that all staff receive fire training at the required intervals with records kept. The fire risk assessment must be reviewed and signed and dated Timescale for action 1st September 2005 1st September 2005 1st September 2005 1st October 2005 1st September 2005 3. 4. 5. OP 26 OP 31 OP 32 13 9,10 26 6. OP 38 13,23, Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP 20 Good Practice Recommendations It is highly recommended that the conservatory is refurbished. Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kenton Hall Nursing Home B53-B03 S423 Kenton Hall Nrsg Hm V220904 080705 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
