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Inspection on 16/12/05 for Kenwith Castle Nursing Home

Also see our care home review for Kenwith Castle Nursing Home for more information

This inspection was carried out on 16th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

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

What the care home does well

Kenwith Castle is a well run home. Medicines are handled in a professional manner. This ensures that residents receive the right medicine at the right time by nursing staff that are qualified to give it. Residents live in accommodation that is comfortable, clean and maintained to a high standard. Procedures are in place that minimise the risk of cross infection to residents and staff follow these. Residents are cared for by competent staff, in sufficient numbers that ensures that their needs are well met. There is a training and development culture at Kenwith Castle, which ensures that residents are cared for by properly qualified and experienced staff. Quality assurance systems at Kenwith Castle enable residents to contribute towards improving the home.

What has improved since the last inspection?

The brochure for the home had been reviewed and covers all the necessary information that prospective residents need. Staffing levels had notably improved since the last inspection due to the recruitment of new staff, which meant that staff had more time to care for residents. Improvements to record keeping made since the last inspection ensure that resident`s financial interests are safeguarded.

What the care home could do better:

Kenwith Castle is well run. On this occasion the inspector did not need to make any legal requirements or recommendations.

CARE HOMES FOR OLDER PEOPLE Kenwith Castle Nursing Home Kenwith Castle Nursing Home Abbotsham Bideford Devon EX39 5BE Lead Inspector Susan Taylor Unannounced Inspection 12:30 16 December 2005 th 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 Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kenwith Castle Nursing Home Address Kenwith Castle Nursing Home Abbotsham Bideford Devon EX39 5BE 01237 470060 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) Two Rivers Investments Ltd Vacancy Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55) of places Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 14/2/1998 15th June 2005 Date of last inspection Brief Description of the Service: Kenwith Castle is situated in a rural area of North Devon, a few miles to the South West of Bideford. The home provides 24-hour nursing care to 55 older people. The building is a large two-storey building, which has been sympathetically converted to retain some of the original features. There are extensive grounds surrounding the home, which command fine views to the front. A lake within the grounds provides a haven for wildlife and also a variety of freshwater fish. A long driveway leads to the visitors’ car park at the front of the home. There is level access and automatic doors to the front entrance. Accommodation is provided for service users on both floors with lift access to the upper level. There is level access throughout the home. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took four and half hours over one day. The focus of the inspection was key national minimum standards covering choice of the home, health and personal care, environment, staffing and management. In addition to this, a legal requirement covering the brochure known as the ‘Statement of Purpose’ was followed up. Six residents gave their views, as did four staff. The inspector also looked at records, toured the building and observed care and practices. The manager had sent a pre-inspection questionnaire to the Commission in the autumn, and the inspector took information from this. At the last inspection, the people living at Kenwith Castle told the inspector that they preferred to be referred to as ‘residents’. This term is used throughout the report. What the service does well: What has improved since the last inspection? Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 6 The brochure for the home had been reviewed and covers all the necessary information that prospective residents need. Staffing levels had notably improved since the last inspection due to the recruitment of new staff, which meant that staff had more time to care for residents. Improvements to record keeping made since the last inspection ensure that resident’s financial interests are safeguarded. 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. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective residents are provided with comprehensive information that enables them to make an informed choice about where to live. EVIDENCE: A requirement in respect of the statement of purpose was followed up. The inspector read a copy of the reviewed statement of purpose. Comprehensive information had been included in the document, which meets the requirements of schedule 1. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The handling of medication in the home is well managed to provide the best outcomes for the residents. EVIDENCE: All staff administering medication are registered nurses. The inspector observed that all medication is taken to the residents for administration to take place and it is recorded immediately after administration. Risk assessments were in place for all residents looking after any of their medicines and secure storage space are provided. Hand written entries made on the Medication Administration Record (MAR) charts had been signed and dated. Hand transcribed entries made on the MAR sheet had two signatures – one of the people making the entry and one of a second competent person. A record of ordering of medicines and all receipts of medicines into the home had been recorded. Medicine requiring refrigeration was kept as per guidance. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Residents live in comfortable accommodation that is suitable for their needs and is maintained to a high standard. Measures are in place that minimise the risk of cross infection to residents. EVIDENCE: The inspector toured the building and met one of three maintenance staff that verified that they are employed for 30-40 hours per week. Records demonstrated that maintenance is carried out in a timely manner. The home was spotlessly clean and free from odours. Resident’s comments were positive in respect of the maintenance and housekeeping in the home, and included: “Everything is spotlessly clean as you can see. Nothing is too much trouble. They make it homely and festive, just look at all the decorations here.lovely”; “The bath is cleaned every day”. A relative who gave written feedback and commented “Rooms are personalised. Cleanliness of the rooms and corridors is excellent.” Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 13 The laundry was clean. Good systems were observed in practice in respect of infection control. Soiled linen and everyday clothing had been separated for washing. Clean clothing had been placed into individual linen boxes that staff told the inspector would be delivered to residents later that day. The inspector observed staff using alcohol gel after tasks. Staff told the inspector that infection control training had been provided for them during the year. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Residents are cared for by competent staff, in sufficient numbers that ensures that their needs are well met. There is a training and development culture at Kenwith Castle, which ensures that residents are cared for by properly qualified and experienced staff. EVIDENCE: Duty rosters seen covering December 2005 demonstrated that staffing levels had improved since the last inspection. The manager verified that several new staff had been appointed following recruitment drive in the Autumn. The inspector observed that staff appeared relaxed and responded to call bells promptly. Residents who the inspector met verified that they were well cared for and their needs were met. The pre-inspection questionnaire stated that 32 of the care staff hold the NVQ level 2 in care. The training co-ordinator showed the inspector records that verified that a further thirteen care staff are working towards the NVQ award. A distance-learning package had been used for the induction of new staff that is linked to the local college. Five training portfolios were seen and demonstrated that new staff had received an induction that met national standards. Care staff verified that they had been given a handbook that incorporates the policies and procedures of the home, and a copy of the Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 15 General Social Care Council code of practice. The inspector spoke to a trainee who verified that they were supervised and had been allocated duties that did not involve hands on care. Records also demonstrated that the professional development of nursing staff was encouraged to ensure that PREPP requirements are met. Certificates were seen on the files, which included tissue viability, infection control and wound management. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 Residents live in a well run home. The quality assurance systems at Kenwith Castle ensure that residents and other stakeholders participate fully in a formal process to improve the service. Improvements to record keeping made since the last inspection ensure that resident’s financial interests are safeguarded. EVIDENCE: Since the last inspection, the Commission had registered the new manager. A condition of registration is that the manager must attain an NVQ level 4 or equivalent in management by 31/10/06. The manager showed the inspector a letter that demonstrated that they had commenced a management course. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 17 Two residents and the manager told the inspector that a ‘Resident’s Committee and forum’ had been set up. Minutes from the first meeting were seen, which demonstrated that membership ensures that there is wide representation from management, staff and residents. A robust and effective quality assurance system - ‘Essence of Care’ – had been used at the home. This covers nine key care areas: principles of self-care; personal & oral hygiene; food & nutrition; continence; pressure area care; safety; record keeping; privacy & dignity and communication. Since being appointed, the manager had undertaken an audit on meals and menus. Feedback had been sought from residents in the form of questionnaires. An action plan had produced to deal with issues raised, and there was clear evidence of improvement as a result. Annual questionnaires had been distributed to relatives and friends; case reviews provide an opportunity for professional such as care managers and G.Ps to air views and raise concerns or other issues. The manager told the inspector that they intended to implement another quality assurance model – RAID – used widely in the NHS, which is better placed for evaluating evidence based care. In 2006, the manager intends to audit the continence care given to residents. Standard 35 was not fully inspected. A recommendation made in respect of record keeping at the last inspection was followed up. The inspector saw that all entries where resident’s money is managed or kept for safekeeping has two signatures as recommended. Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 18 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 x x x Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 19 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. 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. Refer to Standard Good Practice Recommendations Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Kenwith Castle Nursing Home DS0000061785.V253064.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!