Inspection on 25/05/06 for Kilsby House Residential Home

This inspection was carried out on 25th May 2006.

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.

Other inspections for this house

Kilsby House Residential Home 21/08/08

Kilsby House Residential Home 04/07/07

Kilsby House Residential Home 12/01/06

Kilsby House Residential Home 28/09/05

Kilsby House Residential Home 16/11/04

Kilsby House Residential Home 08/07/04

Kilsby House Residential Home 26/01/04

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

CARE HOMES FOR OLDER PEOPLE Kilsby House Rugby Road Kilsby Rugby Warks CV23 8XX Lead Inspector Irene Miller Unannounced Inspection 25th May 2006 08:00 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 DS0000012830.V296253.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. DS0000012830.V296253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kilsby House Address Rugby Road Kilsby Rugby Warks CV23 8XX 01788 822276 01788 824713 kilsbyhouse@aol.com 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) Advent Estates Limited Mrs Gillian Ann Saxton Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places DS0000012830.V296253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home limits its services to the following service user categories. No person falling within the category DE (E) can be admitted where there are 39 persons of category DE (E) already in the home. As part of the total number the home may accommodate a maximum of two people in the category of OP who have a relationship with a service user in the category DE (E). Total number of service users in the home must not exceed 39. 4. Date of last inspection 12th January 2006 Brief Description of the Service: Kilsby House is an extended period property, situated in the village of Kilsby. Which is on the border between Warwickshire and Northamptonshire The home offers care for up to 39 older people who suffer from dementia related conditions and promotes a person-centred approach to dementia care. The house is organised into three units for 15,14 and 10 people, each with its own lounge and a dining room with kitchenette facilities. Group living is practiced and residents are accommodated within a unit following an assessment of individual needs and dependencies taking place. There are two passenger lifts, one in the original house and one in the new extension. The home has a raised (decking) patio area, accessible to the residents. There is a garden, mainly laid to lawn, which is uneven and not fully enclosed. Therefore not accessible to older people with mobility problems. Kilsby is a small village with limited public transport to local towns. Visitors to the home will therefore, require transport arrangements. There are single and shared rooms, all with en-suite facilities to include a toilet and sink. The range of fees is £400 to £450 per week. DS0000012830.V296253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The primary method of inspection used was ‘case tracking’ which involved tracking the care of three residents, through a review of their records and discussion with them where possible. Observation of care practices, discussion with the manager, residents, staff and visitors and included a limited tour of the building. The inspection took place over a period of approximately five and a six and a half following one 3 hours preparation, which included reviewing previous inspection reports, and other documentation in relation to the home. What the service does well: There has been a vast improvement to the information contained within the residents care plans and individual risk assessments, that demonstrated that much work has taken place in this area. The information contained within the care plans was detailed person centred and identified the residents current health and personal care needs. The emphasis on ‘meaningful activities’ is to promote and maintain residents daily living skills, and to provide ‘pleasurable pastimes’ that are individualised, to each person living at the home. One resident was busy helping out with the housework, drying up the dishes another resident was busy entertaining other residents, playing a tune with a set of drumsticks, many residents were singing, one resident took great joy in taking centre stage in singing silent night for everybody. Other residents were enjoying each others company chatting and passing the time of day, one resident said that they could spend time in their own rooms if they wished to, but liked the company of others. Records within care plans contained information on resident’s individual hobbies and interests, such as taste in music, Roy Orbison and Tom Jones, dancing, nostalgic television programmes, such as the Black and White Minstrel Show, and individual resident’s daily diaries recorded what each resident chose to do on a daily basis. Monthly church services take place these services are ecumenical and open to all residents’ faiths, and information was available within the homes newsletter on forthcoming events and dates of visiting clergy. DS0000012830.V296253.R01.S.doc Version 5.2 Page 6 The Commission for Social Care Inspection has received one complaint since the last inspection taking place that the home dealt with appropriately. The registered manager has many years of experience caring for people living with dementia and has in-depth knowledge of the needs of the Client group living at the home. She is well respected by residents, staff and visitors; it was evident through discussion and review of documentation that she is very skilled, experienced and competent to manage the home. What has improved since the last inspection? 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. DS0000012830.V296253.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 DS0000012830.V296253.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process enables prospective residents to make a fully informed choice as to whether the home will meet their needs and expectations. EVIDENCE: Pre assessments were available within the documentation seen. One resident spoken to said that they couldn’t remember whether they had visited the home, prior to moving in, however they said that they know that they are well cared for and felt safe at the home. Staff said that residents and their families are encouraged to visit the home, to meet the residents and staff and invited to stay for lunch, prior to making any decision about moving in. DS0000012830.V296253.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The detailed information contained within the care plans, ensures that resident’s needs are identified and met. EVIDENCE: The care plans and residents individual risk assessments looked at, demonstrated that much work has taken place in this area. The information contained within them was detailed person centred and identified the residents current health and personal care needs. Within the care plans the input from other professionals such as the district nurse and general practitioner was recorded, and the treatment and action taken to address any health care needs was recorded. DS0000012830.V296253.R01.S.doc Version 5.2 Page 10 Within the care plan of one of the resident’s case tracked, there was information available on pressure area care and treatment and a falls risk assessment was in place, which had identified a need for bedside rails to be put into use. However there was no risk assessment in place to identify any possible hazards that the use of bedside rails may present in relation to their suitability and compatibility with the individual bed occupant. The storage and administration of resident’s medication was well managed, however there was some staff signatures omitted on one of the mar sheets (medication administration record) looked at. The home has recently changed to another pharmacy to supply the medications and staff said that this had been a very positive move; the pharmacy has provided medication training, in addition to the accredited medication training that the home already provides to designated staff. The stock medication was stored securely, and plans are in hand to re locate the medication store to an area of the home that would afford more space and allow for a dedicated medications refrigerator to be available. There was information available within the care plans of support available from the residents General Practitioner, district nurse, and community psychiatric nurse. Staff were observed treating residents in a respectful and courteous manner. Residents were addressed by their preferred name and staff were observed to knock on doors before entering. Residents said that they were very happy with the care they received at the home, the registered manager and deputy manager promote a person centred philosophy that fully respects the resident’s rights to privacy, dignity and independence. DS0000012830.V296253.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 at least once during a 12 month period. 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. The lifestyle in the home in general meets the resident’s needs and expectations. EVIDENCE: Residents are cared for within self-contained groups within the individual lounge/diners and kitchenettes, residents were observed to move about independently as they wished, chatting with staff and visitors, choosing were to spend their time. There was some organised activities taking place within one of the lounges, such as a small group of residents playing dominoes The emphasis on ‘activities’ is to promote and maintain residents daily living skills, and to provide ‘pleasurable pastimes’ that are as individual, as each person living at the home. DS0000012830.V296253.R01.S.doc Version 5.2 Page 12 One resident was busy helping out with the housework, drying up the dishes another resident was busy entertaining other residents, playing a tune with a set of drumsticks, many residents were singing, one resident took great joy in taking centre stage in singing silent night for everybody. Other residents were enjoying each others company chatting and passing the time of day, one resident said that they could spend time in their own rooms if they wished to, but liked the company of others. Many of the residents may not always remember the names of the staff who care for them, and for some their ability to verbally communicate may be affected, however residents were observed to be very in touch with their emotions and showed signs of well-being, smiling and engaging with staff who instinctively responded appropriately to the residents non verbal body language. In the front entrance there was a bus stop sign with a bench, the manger said that this serves an important role in alleviating some of the residents anxieties, when they feel that they have got to go ‘somewhere different’. Records within care plans contained information on resident’s individual hobbies and interests, such as taste in music, dancing, nostalgic television programmes, such as the Black and White Minstrel Show, and individual resident’s daily diaries recorded what each resident chose to do on a daily basis. The manager said that time had been invested in rolling out training for staff on quality report writing and care planning, and that improvements to the quality of the information contained within the daily reports (daily diaries) was a direct result of the training that had been made available. Residents were facilitated in pursuing their own interests. There was a pram and dolls ‘babies’ within one of the lounges, and residents were observed looking after the ‘babies’, and clearly got a feeling of self fulfilment from this very meaningful activity The manager said that some relatives had knitted clothes for the ‘babies’, as they could see the important role that they provided. Other items of interest within the lounges was a sewing machine, sensory touch items and items of memorabilia. The registered manager said that for larger social gatherings such as tea dances and parties, the use of the village hall is available, which is across the road from the home. Monthly church services take place these services are ecumenical and open to all residents’ faiths, and information was available within the homes newsletter on forthcoming events and dates of visiting clergy. DS0000012830.V296253.R01.S.doc Version 5.2 Page 13 A Roman Catholic priest also visits the home, on the day of inspection the priest was visiting one of the residents who’s health was declining. The resident’s Roman Catholic faith was very strong; there were details in the care plan for staff to follow to ensure that the resident had full support in practicing their faith, such as the importance of daily prayer and the wearing of their rosary beads. Visitors spoke very highly of the care that their friend received, saying that the manager personally helped their friend by providing the transport and care support to enable the resident to attend an important church anniversary The home has a flexible approach to the times of day that residents get up and go to bed, this was demonstrated within the care plans and daily reports viewed. The care plans demonstrated flexibility in accommodating the individual routines of residents Resident’s weights are closely monitored and dietary preferences recorded within the care plans. The meal on the day of inspection was Toad in the Hole or liver and onions with potatoes, swede and cabbage, followed by egg custard tart. There was fresh fruit available within the individual groups. The food store was well stocked containing a variety of tinned, packet, and fresh vegetables produce. The home endeavours to provide foods that are suitable for residents to eat as finger foods, there was some asparagus tips and baby sweet corn as an alternative vegetable for residents who find using cutlery difficult. Within one of the care plans was information from a dietician to provide advise for eating and drinking problems that the resident was encountering. DS0000012830.V296253.R01.S.doc Version 5.2 Page 14 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that any concerns they may have about the service will be taken seriously and acted upon. EVIDENCE: A complaints procedure was available within each of the lounge/diners. The Commission for Social Care Inspection had received one complaint since the last inspection-taking place, through discussion with the home manager about the steps that have been put into place following the concerns raised, the commission for Social Care Inspection was satisfied that the complaint was dealt with appropriately. Training on the protection of vulnerable adults takes place during induction training, the manager is aware of the vulnerable adults policies on reporting any suspected or actual abuse. DS0000012830.V296253.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The internal environment provides safe comfortable surroundings that are maintained to an acceptable standard EVIDENCE: A limited tour of the building took place and all areas seen were adequately maintained, the building is a large extended period house, many of the rooms within the original house retain the original features. The separate lounge/diners are isolated by doors that are locked with chub keys, as are the corridors leading to staircases and other areas of the house that could present risks to residents, such as the main kitchen and laundry. All members of staff carry a key on their person. DS0000012830.V296253.R01.S.doc Version 5.2 Page 16 The residents’ freedom to independently move from group to group is restricted, however outside of the group units there are many doorways, uneven floors and steps that could cause a person with dementia to become disorientated and could put residents at risk if venturing around the home unsupervised. Outside there are raised seating areas leading from the two ground floor lounges, which are made from wooden decking, to include a garden Gazebo and wooden tables and benches provide a pleasant area for residents to sit. However the remainder of the garden is unsuitable for residents to access, due to the garden having, slopes, steps and not fully enclosed. Within the garden there was a disused fridge, dishwasher and old table, awaiting disposal that looked unsightly. There was also a disused fridge freezer within the staff kitchen the interior was mouldy and the fridge freezer was in need of removal. The manager said that this would be arranged. Residents’ individual rooms are identified by their name and appropriate signage was displayed around the home identifying the location of the toilets and the fire exits. The furniture in the communal areas was suitable with a mixture of different styles of chairs including settees in the lounges. The home was clean and homely, although one en-suite viewed had not been cleaned thoroughly, the manager was aware of this and said that it would be addressed. To reduce the risks of cross infection hand sanitiser is available within the bathrooms, toilets, and laundry and food preparation areas. The laundry was viewed; the home has invested in a laundry system to eliminate the risks of cross infection, the member of staff employed within the laundry was very impressed with the system and showed a pride in their work, saying that ‘it was nice to make sure that the residents clothes were laundered and ironed well, that to be dressed smartly is important to the generation of residents living at the home’ Although the person employed within the laundry endeavoured to keep it clean, the fact that it is carpeted presents cross infection hazards, as the floor cannot be thoroughly cleaned with an appropriate anti bacterial disinfectant. The main kitchen was viewed, all food safety standards were followed, and temperature records, cleaning schedules in place and records were available to demonstrate when these take place. The chef was knowledgeable of the nutritional needs of the residents and special diets required. DS0000012830.V296253.R01.S.doc Version 5.2 Page 17 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): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a trained staff team that are aware of their needs. EVIDENCE: The staffing the staff rota was viewed and the staff ratio was sufficient to meet the needs of the residents within the individual lounges. Staff training records covered mandatory training on health and safety, fire, moving and handling and food hygiene, as well as specific dementia care training on managing challenging behaviour. The registered manager said that the homes director has qualified in dementia care mapping, which is an observation tool devised by the Bradford Dementia Care Group to assess the well being or ill being of people with dementia living within a care setting. It was anticipated that feedback following mapping sessions would provide staff with a greater insight into the emotional needs of residents. The deputy manager has recently gained a diploma in Holistic Dementia Care through the Alzheimer’s Society. Staff employed from China and Poland come through employment agencies specialising in providing staff for the care sector, in addition to interviews DS0000012830.V296253.R01.S.doc Version 5.2 Page 18 undertaken by the agencies, the registered manager conducts telephone interviews to ensure that staff are proficient in speaking English. All staff are employed on a six month probationary period, during which they receive individual supervision to ensure that they have the communication and listening skills required to interact with people living with dementia. All recruitment documentation seen, demonstrated that staff recruitment and supervision is thorough and robust. DS0000012830.V296253.R01.S.doc Version 5.2 Page 19 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 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a home that promotes the residents rights to choice, privacy and dignity and respect. EVIDENCE: The registered manager has in-depth knowledge of the needs of the residents living at the home and is well respected by residents, staff and visitors; it was evident through discussion and review of documentation that she is very skilled, experienced and competent to manage the home. There is an open and inclusive atmosphere within the home, and staff said that they feel supported. DS0000012830.V296253.R01.S.doc Version 5.2 Page 20 During the inspection the registered manager was observed communicating and interacting with residents and staff and visitors in a relaxed and professional way. Staff meetings are held on a regular basis the registered manager and the deputy manager firmly uphold the values of person centred care, and are committed to further improving the management systems and the outcomes for residents living at the home. The resident’s financial and confidential records and records in relation to staff recruitment are stored securely. DS0000012830.V296253.R01.S.doc Version 5.2 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000012830.V296253.R01.S.doc Version 5.2 Page 22 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. 1 Refer to Standard OP19 Good Practice Recommendations The grounds should be kept tidy, attractive and accessible to service users The disused electrical goods that are dumped within the garden and the fridge freezer within the staff kitchen should be appropriately disposed of. To reduce the risk of cross contamination within the laundry room, serious consideration should be given to replace the carpet with a floor finish that is impermeable and readily cleanable. 2 OP26 DS0000012830.V296253.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 DS0000012830.V296253.R01.S.doc Version 5.2 Page 24 - 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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