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Inspection on 21/04/05 for Kilfillan House Nursing Home

Also see our care home review for Kilfillan House Nursing Home for more information

This inspection was carried out on 21st April 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

The home is well managed. The standard of services and care continued to be maintained in a positive and consistent way. Members of staff interact well with the services users. The nurses, carers and supporting staff have defined roles and responsibilities and good teamwork was evident.

What has improved since the last inspection?

The Continuing Care service (for 10 service users requiring palliative care) and the rapid response place was recently restructured by the Local Primary Care Trust, who funded the block care. The users of these services were consulted at the time and the management has agreed to this new arrangement. All service users admitted through these schemes are no longer under the General Practitioner. The arrangement was made between the Primary Care Trust and the local Hospice of St Francis so that all the respective service users are referred directly to the specialist Doctor at the Hospice of St Francis. The doctor makes routine visits three times a week. Construction is underway to widen the entrance space and lift door by using the space to one side of the lift on the first floor. The lift meanwhile remains operational until the day the change is made. The space next to the lift on the first floor in under construction to create a wider entrance to the lift.

What the care home could do better:

The home is currently without a fulltime permanent chef. The agency chef was present on the day of the inspection. The process of recruiting a new chef is underway.

CARE HOMES FOR OLDER PEOPLE Kilfillan House Nursing Home Graemsdyke Road Berkhamstead Herts HP4 3LX Lead Inspector Yoke Lan Jackson Unannounced 21 April 2005 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. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kilfillian House Nursing Home Address Graemsdyke, Berkhamstead, Herts, HP4 3LX 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) 01442 877115 01442 877598 BUPA Care Homes Ltd Mrs Caroline Spring CRH Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (5), Terminally ill over of places 65 years of age (10) Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration. Date of last inspection 6 September 2004 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 boarded 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. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection for the year 2005. The inspector was in the home for three hours. The inspection began with a general observation of the lunchtime routine in the dining room, including observation of staff performance and staff interaction with service users. Several service users spoken with gave positive feedback about the care and services provided. One service user said “I have no complaints. The food is good. I am well looked after”. Another service user commented “ My husband and I are very happy here. We are well looked after. No complaints”. The couple are provided with a double bedroom. Similar positive remarks were echoed by other service users in the home. The members of staff present included nurses, carers, domestic staff, one administrator and the gardener/maintenance worker. Good teamwork was evident. Records examined included care plans, personal allowances and medication records. They were informative, up to date and accurate. The inspection ended with a general discussion with the registered manager regarding staff recruitment and supervision. The home is currently recruiting a new chef. Meanwhile the locum chef (from a known agency) is employed on a temporary basis. (Please see below for details of the inspection findings). What the service does well: What has improved since the last inspection? The Continuing Care service (for 10 service users requiring palliative care) and the rapid response place was recently restructured by the Local Primary Care Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 6 Trust, who funded the block care. The users of these services were consulted at the time and the management has agreed to this new arrangement. All service users admitted through these schemes are no longer under the General Practitioner. The arrangement was made between the Primary Care Trust and the local Hospice of St Francis so that all the respective service users are referred directly to the specialist Doctor at the Hospice of St Francis. The doctor makes routine visits three times a week. Construction is underway to widen the entrance space and lift door by using the space to one side of the lift on the first floor. The lift meanwhile remains operational until the day the change is made. The space next to the lift on the first floor in under construction to create a wider entrance to the lift. 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. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 4 and 5 Prospective service users are supported by the home’s manager to make a decision on choosing to live at the home or not. The registered manager also ensures that the home will only admit a service user if their assessed needs can be met. EVIDENCE: The admission notes and the care plan files of the service users examined confirmed that a full assessment was carried out before the prospective service user was admitted into the home. The home has one emergency bed for immediate admission (without the service user having to go through the hospital admission process). In this situation, all the information for assessing the needs are acquired via the telephone. One service user who was admitted under the Continuing Care scheme for two weeks, is now staying in the home together with his spouse. Each service user has a copy of the signed written contract and the Service user guide on admission. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, and 10 Service users are treated with respect and the care planning system ensures that all their needs are met in an appropriate way. EVIDENCE: The care plans examined have detailed accounts of the health care needs as well as the personal and social needs of the respective service users. They were thorough and up to date. Information was appropriately recorded, including, records on Wound Assessment and Sterling Pressure Sore Severity Scale and the Pressure Sore monitoring Form. The home has a good regime for the treatment of pressure sores with positive results. Several service users spoken with gave positive feedback about the care and services in the home. One service user said “I have no complaints. The food is good. I am well looked after”. Another service user commented: “My husband and I are very happy here. We are well looked after. No complaints”. One lady on two weeks respite care said that “staff help to wash” her. She said that she “is enjoying her stay”. There is a plan of care for each service user. The service users spoken with gave positive feedback about the care and the services given. The members of staff treat them with respect and dignity. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 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 standard(s) 13, 14, 15. Service users are encouraged to maintain links with family and friends. Meals are a highlight of the day and service users throughly enjoy the meals provided. EVIDENCE: The service users are encouraged to exercise choice and control over their lives. They choose the visitors they want to see. Visitors are welcome at any reasonable time. The registered manager ensures that the service users are provided with a choice of menu. The food provided is nutritious and balanced. Lunch time menu included a hot meal. It was noted that the home has a locum chef. However, the feedback from the service users remains positive. One service user commented: “ We have two hot meals a day. I am satisfied with the meals provided”. There were eleven service users having their lunch in the dinning room. Members of staff were ready to lend a hand. Mealtime was unhurried. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 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 standard(s) 16, 17, 18. There is a complaint process that all service users can access, both formally and informally. Staff have been trained to protect service users from abuse and to protect their legal rights. EVIDENCE: The home has a system in place to ensure that the service users are protected from abuse and neglect. Their legal rights and their right to vote are protected and implemented. All the information about the complaint process are in the Service User Guide. A ‘Residents’ Meeting’ is held monthly to allow service users to air their views corporately and individually. Minutes of the recent meetings were examined. The management has an open policy so that service users, members of staff and others can discuss issues before they escalate. A copy of the Hertfordshire Adult Policy and Procedure is readily available. Members of staff interviewed are aware of the procedure including WhistleBlowing Policy and Procedure. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 23, 24,26 Kilfillan House is clean, comfortable and homely. There are ample community spaces for the service users to use, including the sensory garden. The bedrooms inspected are safe, clean and odour free. The en-suite facilities in the bedrooms are adequate for the respective service users. EVIDENCE: The premises are generally clean and tidy. The bedrooms examined have personal items on display that reflects the individual lifestyle. One service user showed the inspector the family photos and the birthday cards she had received from relatives and friends. She pointed to the fresh flowers from her son and a red rose from a close friend. She commented: “ I am very comfortable in my room. The staff are very nice to me”. The new entrance to the existing lift (on the first floor) is currently under construction. The space next to the lift is used to widen the entrance to the lift, including the lift door. The lift remains in operation in the meantime. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 13 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, 28, 29, 30. The home has an effective staff team of nurses, carers and other supporting staff. The nurses have good knowledge of the service users’ health and assessed needs. The members of staff have undergone relevant training to meet the assessed and changing needs of the service users. The recruitment process is thorough and complies with current legislation. EVIDENCE: Staff feedback regarding the assessed needs and the care given were thorough and informative. The written records are concise, consistent and up to date. The carers have training that meets the National Training Organisation (NTO) specification. On the day of the inspection, the gardener was acting as ‘a wheelchair user with restricted mobility’ as part of the provider’s training programmes for all staff. The registered manager is the counter-signatory for the Criminal Bureau record checks and the Protection of Vulnerable Adult (POVA) check, which is undertaken on-line. This ensures that all new staff have the appropriate police and POVA checks without delay. New Staff commence work in the home only when these checks are cleared. The home is in the process of recruiting a new chef. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 14 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) 38. 31, 32, 34, 35, The standard of care and the services provided are maintained in a consistent way. The general administration and management of the home are well organised and the home is run in the best interest of the service users. Their health, safety and welfare are promoted and protected. EVIDENCE: The service users spoken to gave very positive feedback. One service user said: “ I am very pleased with the care I am getting. I am only here for two weeks. The only complaint I have is that I am still waiting to pay the £10 that I owe the home for my hairdo. Could you please ask one of the staff to come and collect the money?” The service users’ personal allowances are safeguarded by the accounting and financial procedures. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 15 Members of staff spoken to confirmed that they have regular supervision and training. One nurse commented that she “enjoys working in the home”. Positive interaction between management and staff was evident. All the financial records checked were thorough, accurate and up to date. One of the administrative staff is responsible for ensuring that the accounting record and bank statements are up to date and that all receipts of expenses are retained. The home is not involved with the financial affairs of the service users apart from the personal allowances. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 16 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 3 3 3 3 x 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 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 x x x 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 Standard No 16 17 18 Score 3 3 3 3 3 x 3 3 x x 3 Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 17 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. 1. Standard Regulation Requirement There were none. Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations There were none. Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ 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 Kilfillan House Nursing Home I52 s19442 Kilfillan House Nursing Home v223102 210405 Stage 4.doc Version 1.30 Page 19 - 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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