CARE HOMES FOR OLDER PEOPLE
Kilfillan House Nursing Home Graemsdyke Road Berkhamsted Hertfordshire HP4 3LX Lead Inspector
Bijayraj Ramkhelawon Unannounced Inspection 11th April 2007 10:15 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 Kilfillan House Nursing Home DS0000019442.V335893.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. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kilfillan House Nursing Home Address Graemsdyke Road Berkhamsted Hertfordshire HP4 3LX 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) 01442 877 115 01442 877 598 springc@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited Mrs Caroline Spring Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (5), Terminally ill (1), of places Terminally ill over 65 years of age (10) Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. This home may accommodate 32 older people who require nursing care. This home may accommodate 5 people (aged 50 or more) in need of convalescent nursing care. This home may accommodate 5 people (aged 50 or more) with physical disability who require nursing care. This home may accommodate up to 10 service users who are terminally ill. The home may accommodate one named service user who has not yet attained the age of 65 years, under the category of TI 21st June 2006 Date of last inspection Brief Description of the Service: Kilfillan House, operated by BUPA Care Homes Limited, is a Nursing Home for 32 elderly service users. The home is registered for nursing and the terminally ill category, physical disabilities (5) and convalescence (5). The building is situated in a quiet residential road about half a mile from the town centre of Berkhamsted. The front of the building is mainly used as a parking area bordered by some mature border plants and trees. There is limited space to the back of the building since part of the ground was sold off. There are ample parking spaces on the main road. The entrance leads to a large reception area, the dinning room and the kitchen. The administrative office is to the side of the reception area. The nurses station has been moved to a more spacious room on the first floor. The bedrooms are of single-occupancy with en-suite toilet facilities. They are situated mainly on the first floor. However there are a number of bedrooms on the ground floor on one side of the building. There are a number of assisted bathrooms and toilet facilities within easy reach. The home has a lounge that leads to a large conservatory that is being used as a second lounge/activity room. The conservatory leads to an average size garden with seating areas for the service users and visitors. Part of the garden has been developed into a Sensory Garden that is now in full use. Current fees were quoted as between £970 and £1485. A copy of the ‘Statement of Purpose’ and ‘Service User’s Guide’ is available at the care home. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 11th April 2007 and took one day. Feedback from people living at the care home, visitors and staff was sought during the inspection. A completed pre-inspection questionnaire was received from the registered manager and information from this questionnaire formed part of the overall inspection process. Policies and procedures, a sample of people’s care plans, staff files and other documents were examined. General observation including interaction between staff and people living at the care home, the management and administration of medicines, adherence to health and safety regulations, fire safety and other linked legislation were also observed. What the service does well: What has improved since the last inspection?
Separate care plans were devised for each aspect of care including each wound or sore. The management and administration of medicines were kept in good order. A choice is provided in the menu for cooked meals. Repair works identified in the last inspection were carried out. Staff were now provided with training in infection control. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 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 Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate information is available to people looking to live at the care home so that they can make a decision about the home. Each person at the care home has a comprehensive assessment of his or her needs carried out prior to moving to the home. EVIDENCE: Adequate information was available to people looking for a care home and their relatives so that they could make an informed decision about the home. Care plans examined included an assessment of needs for each person. Reports from other professionals formed part of the care plans. There is one emergency bed for immediate admission (without the person having to go through the hospital admission process). Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the care home confirmed that they were treated with respect and dignity. Care plans were detailed and comprehensive. However, records for pressure care need improving so that the treatment provided can be evaluated and service users are not put at risk. EVIDENCE: People living at the care home confirmed that they were well cared for and their individual needs were being met. Good care practices and interactions between staff and them were observed. Residents were appropriately dressed, well groomed and they confirmed that staff addressed them by their preferred names. The care plans examined have detailed accounts of the healthcare and personal needs of each person. However, care plans for people with pressure ulcers and assessed as being at risk of pressure ulcers did not indicate what
Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 10 preventative measures were being taken to minimise the risks. The size and depth of each wound was also not recorded. Nevertheless, there were photographs taken on a monthly basis to show that the current conditions of the sores and although records in the daily notes showed that the sores were improving and getting better, the size and depth of sores was not recorded to indicate the progress being made in the healing process. The home has a good rapport with various healthcare professionals and other specialists. The doctor from the Hospice of St Francis visits all people requiring palliative care. The Hospice provides training to staff in palliative care. Records of management and administration of medicines were kept in good order. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 11 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- 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the care home confirmed that they were given the opportunity to participate in all aspects of daily living. Day care activities were arranged and provided. Autonomy and choice were being promoted. EVIDENCE: People were encouraged to exercise choice and control over their lives. A weekly programme of activities was planned and displayed on the notice board and staff stated that people living at the care home were informed and reminded on the day of which activity was being held. On the day of the inspection, the hairdresser was attending to people’s hair. It was noted that others were participating in activities; some were listening to music, reading newspapers, chatting to others and watching T.V. The lunch was observed and tables were laid nicely and a choice of drinks was available and there was individual cutlery. People spoken to were
Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 12 complementary of the food provided. It was noted that staff were assisting people with their meals in a sensitive and unhurried manner. The menu now has a choice of cooked meals provided at lunchtime, which is the main meal of the day. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 13 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure that all people living in the care home can access, both formally and informally. Staff have the appropriate training to ensure that people are protected from abuse. EVIDENCE: A copy of the complaints procedure was available to prospective and current people in the care home. Those spoken to said that they were aware of the complaints procedure but would prefer to speak to a member of staff or the manager if they had any concerns. Staff confirmed that they have received training on Protection of Vulnerable Adults. No complaints have been received since the last inspection, however, 7 compliments were seen. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 14 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, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and generally well maintained. Bedrooms were personalised offering a homely, lived in feel. The buildings and the surrounding grounds are well maintained. EVIDENCE: The premises appeared tidy and well maintained. People’s bedrooms were personalised, appeared comfortable and clean. Service users spoken to said that they were very pleased with their bedrooms and the facilities provided. The items displayed reflected their individual lifestyles. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 15 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 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an effective and dedicated team of nurses, care workers and other supporting staff. They have good knowledge of the health and assessed needs of people living in the care home. The training programme for staff was structured and consistently maintained. The recruitment process was thorough and complied with legislation to ensure the protection of people in the care home. EVIDENCE: Adequate numbers of staff are rostered on duty per shift during the day and night. People living in the care home were complimentary about their rooms, staff and food. They said that ‘ staff are caring, nice, they look after us and are very kind’. The majority of the care staff have completed their NVQ Level 2. Staff files examined had all the relevant documents required by this standard for the protection of the people living in the home. Staff spoken to confirmed that they have received appropriate training, this included statutory training. They also said that they been given a copy of the General Social Care Council Code of Conduct. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures were in place to ensure that service users’ rights were protected. There was an enthusiastic, dedicated and caring staff team who took great pride in the service provision. The health, safety and welfare of people living in the care home was generally promoted and protected. However, bathrooms are used as storage areas, which does not present as a homely environment, and the ground floor bathroom used for storage was not locked which might leave people at risk of accidental injury. Some improvements to food hygiene procedures are required for the protection of all residents. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 17 EVIDENCE: Staff confirmed that the registered manager operated an open door policy to staff, people living in the care home and to their representatives. Good professional interaction between staff and people living in the home was observed. People were very complimentary of the staff, the care and service provision and their accommodation. Evidenced of complimentary feedback (both written and verbal) have been received from family members and visitors. However, bathrooms were being used for storage, and the ground floor bathroom, which stored equipment, chairs and other furniture, was kept open with no appropriate sign displayed to prevent people entering this room and tripping over. The fridge and freezers in the kitchen were not provided with a thermometer and the food probe was being used to check the temperature. Sugar, tea and coffee were stored in open containers in the main kitchen. The staff in the kitchen said that there were no lids provided. Evidence was seen that all financial expenditures for service users’ personal allowances were kept up to date and in good order. However, a list was not kept of all valuables handed over for safekeeping. Care staff spoken to and staff files checked did not show that formal supervision was not being received at least 6 times a year. The manager said that a new induction programme was being implemented and a plan for formal supervision was being devised. All statutory records were available for inspection and maintained in accordance with legislation. Staff spoken to were aware that service users can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures in place to ensure that the health, safety and welfare of people were promoted and protected. These records were accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. The CSCI has been kept informed of all accidents. A valid insurance certificate was displayed in the reception area and this offered cover of no less than £5 million. Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 18 3 3 X X X x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 3 2 Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 19 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 OP7 Regulation 15 (1) Requirement a) The size and depth of each pressure ulcer must be recorded. b) A record of the type of pressure relieving mattresses/cushions and equipment provided for service users who are at risk of pressure sores should be kept. Adequate storage space must be provided so that bathrooms are not used as storage. Ground floor bathroom used for storage must be kept locked and appropriate sign displayed. Timescale for action 30/05/07 2. 3. OP38 OP38 23 (2) (l) 13 (4) (a) 29/06/07 30/05/07 Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP35 OP36 OP38 Good Practice Recommendations A list of all valuables handed over for safekeeping should be kept. Care staff should receive formal supervision at least 6 times a year. a) A thermometer should be provided for each fridge and freezer. b) Suitable containers with lid should be provided for sugar, coffee and tea stored in the main kitchen. A record of the temperature of the freezer in the basement should be kept. 4. OP38 Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kilfillan House Nursing Home DS0000019442.V335893.R01.S.doc Version 5.2 Page 22 - 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!
