Inspection on 04/01/07 for Kenwith Castle Nursing Home

This inspection was carried out on 4th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

Other inspections for this house

Kenwith Castle Nursing Home 24/03/09

Kenwith Castle Nursing Home 16/12/05

Kenwith Castle Nursing Home 15/06/05

Kenwith Castle Nursing Home 03/11/04

Kenwith Castle Nursing Home 20/08/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kenwith Castle Nursing Home Kenwith Castle Nursing Home Abbotsham Bideford Devon EX39 5BE Lead Inspector Susan Taylor Key Unannounced Inspection 10:00 4 & 5th January 2007 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.V328630.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. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 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 Mrs Rae Vanstone Care Home 59 Category(ies) of Old age, not falling within any other category registration, with number (59) of places Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of placements will be fifty-nine (59) in the category of Older Persons (OP) who may require nursing 16th December 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 (not including people with dementia or mental health problems). 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. The current fees range from £500 - £680 per week. Additional charges are made for hairdressing (dependent upon individual requirements), chiropody (£10 per session), physiotherapy (£10 per session), toiletries and newspapers (dependent upon individual requirements) Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, carried out on the 4th & 5th January 2007 beginning at 9:30 a.m. lasting approximately 12 hours. The inspection included a full tour of the home and discussion with several staff including the manager, care staff, registered nurses, the chef and a maintenance person. The Inspector also spoke to a number of residents and who offered their opinions on the food, the environment and staff who work at the home. At the same time, the Inspector observed care practices at staff delivered care to residents. Surveys were sent to eight residents, three relatives, ten staff and three health and social care professionals. Comments from four staff, five residents, two relatives and two health and social care professionals are incorporated within the report. In summary people who live in the home wrote “Kenwith Castle is a wonderful place”; “The staff is very kind and helpful especially when I have sad days”; “The staff is always ready to listen”; “Everyone is very helpful” and “I am very pleased for the help I get” ; “We have a very good doctor”; “I was shown everything. They was very helpful about everything”; and “we have lovely grounds, which we can go out in also we have plenty of space inside where we can all go to”. Health care professionals who visits residents regularly felt that the home had a good relationship with them and always took their advice. Relatives felt that on the whole the care that their relations received was good. What the service does well: Residents feel said that Kenwith Castle is a spacious and comfortable place to live. The home obtains important information about residents prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet their needs. Care plans are well structured around what each person wants from the team. The team of staff have good links with professionals, which helps to improve residents’ health. The home provides a good level of planned and spontaneous activities that are appropriate both in choice and structure for older people. At the same time, residents are treated as individuals who have diverse needs, interests and different backgrounds. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 6 The home has an open feel. Residents say that they have the freedom to do what they want to. At the same time, they are confident about the way that staff protect their property and money that is kept securely for them. Contact with families and friends is encouraged and people who need support to do this get it. There is a good choice of appetising and well-balanced meals at Kenwith Castle. Residents said that the choice was good, but they would like plainer meals. What has improved since the last inspection? What they could do better: Some of the residents have complex nutritional needs and the home does not use a recognised tool to assess these. A recommendation has been made. The manager must always ensure that trainee carers are supervised and are not expected to undertake tasks before they have received appropriate training. This will ensure that only experienced and qualified staff deliver care to people who live at the home. A recommendation has been made. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 7 Shortfalls were seen which would prevent the home from ensuring that they have the right people to care for residents’ and this ultimately puts them at risk. A legal requirement has been made. The registered manager said that they would prioritise this. The manager needs to improve the frequency and availability of supervision of staff, particularly to night workers and qualified nurses, to help them work safely and give them the support and guidance they need when caring for residents. A recommendation has been made. 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. Kenwith Castle Nursing Home DS0000061785.V328630.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 Kenwith Castle Nursing Home DS0000061785.V328630.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): 1,3, 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Information given to prospective residents enables them to make an informed decision about whether Kenwith Castle is the right home for them. The home has a good admission procedure that is risk based and establishes at the outset individual needs so that these are well known by the team delivering care. This could be improved further to include assessment of individual nutritional needs using a recognised tool. The home does not offer intermediate care; therefore no judgement has been made about this. EVIDENCE: In a survey five out of eight residents who responded verified that they had been given good information that had helped them to make their decision about moving into the home. On making the move a resident wrote, “I was Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 10 shown everything. They were very helpful about everything”. The home’s brochure, including the statement of purpose and guide for residents was seen next to seating in the reception area. This was comprehensive and gave detailed information about what prospective residents might expect from the home. Six care files were examined and people’s needs were tracked to establish whether the care delivered was appropriate. Nursing staff told the inspector that the manager assessed prospective residents prior to admission to ensure that their needs could be met at the home. Comprehensive assessments were seen on all the files, which also identified risks with regard to tissue viability, falls, manual handling, and continence. All of the assessments had been regularly reviewed. The inspector read continence assessments that had been sent to the continence nurse specialist to obtain appropriate aids for the individuals concerned. Whilst the home has a policy and procedure on food safety and nutrition it does not deal with the complex needs of some of the residents currently residing in the home. Two residents with complex needs had not had their nutritional needs assessed using a tool such as the ‘Malnutrition Universal Screening Tool’ (available at www.bapen.org.uk). The manager verified that the home does not offer intermediate care. Kenwith Castle Nursing Home DS0000061785.V328630.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 This judgement has been made using available evidence including a visit to this service. Kenwith Castle has a good care planning process that provides clear information about the needs of the residents and how they are to be met. The home maintains good professional relationships with specialist people and implements their advice to the benefit of the residents. Procedures are followed that ensure that residents receive the right medication, as prescribed, at the right time. Additionally, the home has improved the way it records medication that is prescribed by GP’s. Staff deliver care to residents in a respectful way that maintains their dignity. Good risk management was seen that ensures residents are cared for safely. EVIDENCE: Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 12 In a survey, five out of eight residents felt that they received good care from the staff. One person also wrote, “I am very pleased for the help I get” and “We have a very good doctor”. Six care files were examined and had been regularly reviewed. Desired outcomes for each need were clearly stated and had achievable goals. Six residents needs were tracked and particularly focussed on the outcomes of care in respect of their nutritional, continence and medication needs. Each person had a nominated key worker whose responsibility it is to ensure that the care plans are current and the identified needs met. When asked about this a relative said, “no one knows who they are” [key workers]. In a survey five out of eight residents responded and verified that they were consulted about their care and felt listened to. The inspector saw evidence on service users files that verified the home has a professional relationship with the general practitioner with whom all the residents are registered. In addition to this there are good links with the mental health and social services teams. In a survey, two healthcare professionals verified that the home communicated clearly and worked in partnership with them. At the same time, both felt that medication was appropriately managed in the home. In the case of the six residents, the inspector saw records that demonstrated that specialist’s had been consulted and their advice implemented. These included a physiotherapist, continence nurse specialist, chiropodist and psychiatrist. The home had clear policies or procedures about risk assessment and management, which had been implemented. All of the care files had guidance on action to be taken to minimise identified risks with regard to tissue viability, falls, manual handling, and continence. All of the assessments had been regularly reviewed. The inspector particularly looked at the decision making process linked to the use of bedsides. Detailed records were seen in individual care files that were explicit and clarified why bedsides were being used for that individual. It was apparent; that nursing staff had carefully considered the risks and had outlined measures to ensure that bedsides were used safely for the individuals concerned. Five induction records seen had a certificate to verify that person had been assessed as competent to handle medicines safely. The inspector observed a nurse administering medication during lunchtime. Good practice was seen. The home uses a monitored dosage system. Secure storage facilities were seen that meet legal requirements. Qualified nurses are responsible for stock taking and the inspector examined records that demonstrated that this is done on a monthly basis. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and the inspector tracked medication administered to three residents. Records accurately reflected medication having been administered as prescribed by the GP. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 13 Kenwith Castle Nursing Home DS0000061785.V328630.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 This judgement has been made using available evidence including a visit to this service. Routines and activities are flexible and suited to individual residents needs. Residents are enabled to exercise choice and control over their lives whilst at the same time encouraged to maintain contact with friends and family in the community. Nutritious meals are provided for residents, however, these do not always meet individual preferences and tastes and this needs further exploration with them. EVIDENCE: In a survey, five out of eight residents responded and verified that that they Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 15 were satisfied with the level of activities available. People wrote comments like [Activities] “are very good”. In a survey, staff wrote “it gives all it’s residents the opportunity to participate in social activities on a regular basis”. The inspector read the programme of activities for the week beginning 7th January 2007. This listed opportunities for residents to attend three religious services, a quiz, group games, and the cocktail bar for drinks and a chat. Whilst touring the building the inspector saw that the home had plenty of resources and suitable equipment to allow them to vary the planned and activities that happen at the home. One to one sessions had been arranged for people who did not want to take part in group activities. The inspector examined the visitor’s book and saw that a wide range of people including relatives sees residents and staff. Residents during lunch told the inspector that they could see whom they wanted to when they wanted to. A relative said that they were made “very welcome by the staff when I visit”. Additionally, in a survey another relative verified that they were welcome in the home at anytime and could visit their relative/friend in private. There were mixed views regarding the quality of the meals provided. In a survey five out of eight residents wrote, “meals should be plainer, not too much spice and cooked well and a better variety could be improved” and “I usually confine lunch to soup and sweet, partly because I’m not very hungry and because I do not find main courses and the way they are cooked at all attractive”. All of the residents, did, however feel that there was sufficient choice. Lunch was served during the inspection, which was well balanced, appetising and alternatives were offered. At the meal, residents told the inspector that the meal was “enjoyable” and “very tasty”. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 16 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 This judgement has been made using available evidence including a visit to this service. Kenwith Castle’s arrangements for the protection of vulnerable adults, including dealing with complaints generally ensure that residents are protected and able to voice their concerns. EVIDENCE: On a tour of the building the inspector saw that there was a copy of the brochure and guide in the reception area that covered the complaints procedure. In a survey, five residents verified that they were aware of the complaints procedure. They also wrote positive comments about staff such as “The staff is very kind and helpful especially when I have sad days” and “The staff is always ready to listen” and “Everyone is very helpful”. Four out of ten staff responded in a survey and verified that they had received adult protection training. The vulnerable adults procedure was seen in the nursing offices on both floors of the home and is accessible to staff. In the pre-inspection questionaire, the manager had verified that no referrals had Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 17 been made to the Protection of Vulnerable Adults list in the previous twelve months. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents at Kenwith Castle live in comfortable accommodation that is suitable for their needs and is maintained to a high standard. Staff have received training and implement good practice to minimise the risk of cross infection to residents. EVIDENCE: In a survey five out of eight residents felt that the home was well maintained and clean. One person also wrote “we have lovely grounds, which we can go out in also we have plenty of space inside where we can all go to”. The inspector toured the building and met maintenance staff. Records examined Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 19 verified that maintenance is carried out in a timely manner. The home was spotlessly clean and free from odours. The inspector interviewed five staff that all understood good practice principles to minimise the risk of cross infection. A ‘no touch’ technique was observed as staff dealt with soiled linen. Residents showed the inspector a box in their bedrooms that is used to deliver their clean clothes from the laundry. Domestic staff told the inspector that antibacterial spray is used every day to clean the boxes before clean clothes are put in them and returned to people. Staff told the inspector that infection control training had been provided for them. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Trainee carers had supplemented day to day staffing levels throughout the Summer 2006 and had been expected to undertake tasks for which they are not trained to do causing frustration amongst other staff and residents. However, by addressing this issue the manager has ensured that residents are cared for by competent staff, in sufficient numbers according to their individual assessed needs. The home has robust recruitment procedures to ensure that the right people are employed to care for vulnerable people. The manager needs to ensure that these are followed consistently to ensure that residents are fully protected. Kenwith Castle has a training and development culture, which ensures that residents are cared for by properly qualified and experienced staff. The manager needs to improve the frequency and availability of supervision for night workers and qualified nursing staff. EVIDENCE: In a survey five out of eight residents felt that there were sufficient staff. Similar, comments were made at the inspection. The inspector observed that there was extra catering and care staff on duty around the lunchtime period Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 21 and was told that this was to ensure that residents didn’t feel rushed and got the support they needed. However, in a survey a resident wrote, “Seems to be always short staffed”. This was also highlighted by staff who wrote [there is a] “severe lack of care assistants, more staff at night [is needed]…it is impossible to provide the full care they [residents] expect and are entitled to” and [there should be ] “more staff day and night” and “although we could do with more staff at times i.e. carers the clients are all very well taken care of”. Similarly, a relative told the inspector that the home was “very short of staff at night in the evenings”. In a survey, another relative felt there there were not always sufficient numbers of staff on duty. The inspector examined duty rosters for covering the period 1/5/06 to 31/5/06 and the week of the inspection [4th & 5th January 2007]. The inspector interviewed five staff and discussed the level of needs that residents had with them. During these discussions, staff verified that trainees were not expected to do personal care for residents on their own. However, one person told the inspector that they had kept being asked to do things that they had not been trained to do such as moving and handling residents. When auditing the list of names and positions provided prior to the inspection against the duty rosters, the inspector found that ‘trainee’ carers had been included in the overall staffing levels on a number of occasions (1st, 7th, 8th 15th and 23rd May 2006). This was discussed with the manager who told the inspector that the problem had arisen due to unforeseen sickness and not being able to get cover at short notice from agencies. The inspector was shown records demonstrating that three local nursing and domiciliary agencies had been and continue to be used to cover periods of absence including sickness of staff. Staff interviewed further verified this. Ratios of care staff to residents had been determined according to assessed needs and calculated using Department of Health guidance. The manager told the inspector that it had been made clear to all staff that trainees were supernumery to staffing levels and should not be expected to undertake tasks for which they are not trained to do. The inspector observed that staff were unhurried and attended to residents needs in a timely manner. Four out of ten staff responded in a survey verified that written references, including a criminal records bureau and POVA check, had been obtained by the home prior to their employment. The inspector examined five personnel files. Four out of five files had two written references. Two files had old CRB certificates that related to a previous period employment. The manager told the inspector that a POVA list check had been sent for but had not arrived at the time of the inspection. According to the pre-inspection questionnaire, one person had commenced employment on 2/7/06 and another on 5/1/06. CRB and POVA certificates had been obtained for all the other staff prior to employment. The manager verified that annual checks were done of the registration status of each nurse, with the regulatory body, to ensure they are still allowed to practice as a nurse. Additionally, the inspector was shown a list showing the outcome of these checks. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 22 Four out of ten staff responded in a survey and verified that training opportunities were made available to them. Additionally, all of the staff that the inspector met verified that they had received induction training and were encouraged to undertake courses such as the national vocational qualification in care practice. The five staff that the inspector met all verified that they had been given a folder containing policies and procedures and a leaflet about General Social Care Council standards. The deputy manager is responsible for managing training in the home, and showed the inspector improvements that had been made to the induction process. These ensured that all staff followed ‘Common Induction Standards’ and included an adjusted version for qualified staff. Five staff interviewed had varying levels of experience of supervision. Those with the least experience felt that they were well supervised and had regular one to one sessions with their supervisor. Similarly, in a survey four out of ten staff that responded verified that they receive regular one to one supervision and their practice is assessed. Conversely, one person working night duty wrote, “night supervision would be difficult” and [supervision meetings, including one to one, observation of practice and group meetings, do not take place because] “they are too busy”. Similarly, new qualified nurses verified that supervision and assessment of their practice had been frequent at the start of their employment but had tailed off. This was discussed with the deputy manager who verified that the home did not have a formal system of regular supervision of qualified staff as it did for carers. The inspector saw records demonstrating that carers received regular supervision and appraisal. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 23 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 & 38 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and qualified to run the home and does so effectively for the people who live there. Quality assurance systems are evident and ensure that resident’s; staff and visitor’s views are respected in this home. The home has improved its financial procedures so that residents’ interests are safeguarded. Health and safety issues are managed effectively and protect residents, staff and visitors. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager is a qualified nurse with extensive management experience. The inspector was shown a certificate verifying that she had attained the Diploma in Management in September 2006. Additionally, the manager told the inspector that she had enrolled on a course covering Health policy and promotion with a view to achieving a BSc(Hons) degree. The inspector discussed quality assurance with the manager who verified that two professionally recognised systems are used – ‘The Essence of Care’ and RAID (Review, agree, implement and demonstrate). The manager showed the inspector work undertaken by staff to look at the quality and delivery of continence care, palliative care, prevention of falls and nutrition for residents. The projects were evidenced based and staff had used widely accepted academic databases to research their work. In a survey, residents’ wrote “Kenwith Castle is a wonderful place” ; “The staff is very kind and helpful especially when I have sad days”; “The staff is always ready to listen”; “Everyone is very helpful”; “I am very pleased for the help I get”; “We have a very good doctor”; and “I was shown everything. They was very helpful about everything”. Two healthcare professionals verified in a survey that they were satisfied with the overall care provided to residents within the home. Similarly, a relative verified that they were satisfied with the overall care provided. However, they did comment about “the lack of care given to floral gifts….they wither through lack of water or worse still, they remain there in foul smelling stagnant water”. Records showing how money is managed on behalf of residents were inspected. These were well kept, and accurately recorded the correct balance seen. Entries had been signed for and where appropriate two signatures seen. Receipts corresponded with entries for items such as chiropody, hairdressing and newspapers. Secure facilities are used to safeguard resident’s money Comprehensive Health & Safety policies and procedures were seen, including a poster displayed stated who was responsible for implementing and reviewing these. Certificates seen on files examined verified that staff had attended infection control and manual handling training in the past 12 months. The inspector observed hand sanitizer being used by staff to minimise the risk of cross infection. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. Residents, relatives and staff told the inspector that the alarm was regularly checked. Certificated evidence verified that the hoists had been regularly maintained. First aid equipment was clearly labelled. Some of the staff on duty verified that they held a current first aid qualification having completed the National Vocational Qualification in Care. Good manual handling practice was observed as carers transferred residents from wheelchairs to chairs in the dining room at lunchtime. Electrical appliance checks and risk Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 25 assessments had been reviewed in the last twelve months. Data sheets were in place and staff spoken to understood the risks and how to minimise these in respect of chemicals used in the building mainly for cleaning and infection control purposes. The home has an accident procedure that had been followed. Entries tracked by the inspector established that appropriate action had been taken following reported accidents. The manager told the inspector that she regularly audited accidents and incidents occurring in the home to ensure that these were kept to a minimum. Kenwith Castle Nursing Home DS0000061785.V328630.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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 x x 3 Kenwith Castle Nursing Home DS0000061785.V328630.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. 1 Standard OP29 Regulation 19 (1)(b)(i) Requirement The registered person shall not employ a person to work at the care home unless - subject to paragraph (6), (8), (9) her has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 9 of schedule 2. The manager must ensure that satisfactory references including POVA checks are obtained prior to employment. Timescale for action 31/05/07 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 Refer to Standard OP2 Good Practice Recommendations Nutitional needs of residents should be assessed using a tool such as the ‘Malnutrition Universal Screening Tool’ (available at www.bapen.org.uk). DS0000061785.V328630.R01.S.doc Version 5.2 Page 28 Kenwith Castle Nursing Home 2 OP27 3 OP30 Staff providing personal care to residents should be at least aged 18 and be appropriately trained to deliver such care. Trainees should not be included within the overall staffing levels on a day to day basis. The frequency and availability of supervision should be improved for night workers and qualified nursing staff. Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Kenwith Castle Nursing Home DS0000061785.V328630.R01.S.doc Version 5.2 Page 30 - 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. 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