Inspection on 04/07/07 for Kilsby House Residential Home

This inspection was carried out on 4th July 2007.

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 25/05/06

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 Residential Home Rugby Road Kilsby Rugby Warks CV23 8XX Lead Inspector Sarah Jenkins Key Unannounced Inspection 4th July 2007 07:40 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 Kilsby House Residential Home DS0000012830.V340521.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. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kilsby House Residential Home 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 Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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. Date of last inspection 25th May 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 single and shared rooms, the majority of which (85 ) have en-suite facilities to include a toilet and sink. There are two passenger lifts, one in the original house and one in the new extension. The home has a two raised (decking) patio areas, accessible to the residents. There is a garden, mainly laid to lawn, which is uneven and not fully enclosed. It is 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. The range of fees is £348.55 to £480 per week. This information was confirmed as current on 04/07/07. Further information about the home in the form of the Statement of Purpose, Service Users Guide or most recent inspection report can be obtained from the Registered Manager or Registered Owner at the Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 5 home. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting 3 service users and tracking the care they receive through meeting with the service users, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited during the morning to observe practices by staff and to meet with service users. Service users have various forms of dementia and thereby communication for some is difficult. Establishing Service Users choices and informed decisions is dependant to some extent upon the consistency of staff, service users relationships with staff, and the quality of communication. Feedback obtained from Service Users in this report was in part through observations of their relationships with staff, and also through interpretations of their general levels of happiness with their routines. The pre-inspection questionnaire filled in by the Registered Manager prior to the inspection and eighteen feedback comment cards received by the Commission for Social Care Inspection in May, also informed the inspection. Feedback was mainly positive, and feedback from visitors particularly so. What the service does well: The home creates a positive environment for service users with dementia, enabling them to lead happy and fulfilling lives. Staff at the home are warm responsive and caring, and the quality of their training and understanding of the needs of the client group for which they care, leads to the very good outcomes for service users which were observed at the time of the inspection. The home is well managed by a caring and committed management team. The Registered Manager is well qualified for her role. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Kilsby House Residential Home DS0000012830.V340521.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 Kilsby House Residential Home DS0000012830.V340521.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): 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: There was evidence of good pre-admission assessment information and a process of admission that enables service users to feel confident. Service users had an initial care plan drawn up, based on this information by the time they were admitted to the home. A recently admitted service user assured the Inspector that she was happy with the arrangements and appeared to have settled in well. The Inspector had an opportunity to meet with a relative who is currently assisting a prospective Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 10 service user. She informed the inspector that both she and her relative had been very well supported by the home. Staff had been sensitive, understanding and supportive to both her and her relatives needs. She was confident in the process that had been conducted to check the home would be suitable for the needs of the prospective service user. Kilsby House Residential Home DS0000012830.V340521.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 excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit greatly from the competence shown by staff at the home in this outcome area. The detailed information contained within the care plans, ensures that service users needs are fully identified and met. EVIDENCE: The information contained within care plans and risk assessments was detailed, person centred, and identified the service users current health and personal care needs. A visiting relative confirmed that she felt fully involved in the care plan and was invited to the regular reviews Within the care plans the input from other professionals such as the district nurse and general practitioner was recorded, together with the treatment and action taken to address any healthcare needs. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 12 Information was available on any specialist care needs and the ways in which these were being addressed. The use of bedside rails had been appropriate approved for certain service users by the local General Practitioner surgery but advice was given on the need for the District Nurse to be involved in the regular review of these to assess their continuing suitability. 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, and advice was given to ensure clarity on the Medication Administration Sheets sheet about what medications were currently administered. Staff were observed treating residents in a respectful and courteous manner. They were observant to all modes of communication among service users and quickly picked up and responded to service users expressions of need. Staff were observed to delay attending to the ordinary daily routines in the units when service users showed a need to communicate with them. Staff sat down with such service users and showed a warmth and genuine interest in the interaction. Service users showed 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 service users rights to privacy, dignity and independence. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 13 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. The lifestyle in the home in general meets the resident’s needs and expectations. Service users are active and stimulated to lead fulfilling lives. EVIDENCE: Service users are cared for within self-contained groups within the individual lounge/diners and kitchenettes. Service users were observed to move about independently as they wished, chatting with staff and visitors, choosing where to spend their time. There was evidence in the records and in the equipment available of the many opportunities for activities that service users have. Many service users were observed to be enjoying such activities through the morning, such as accompanied walks in the garden, musical activities, reading newspapers and magazines which had been delivered, and helping staff in the kitchenette areas. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 14 The emphasis on ‘activities’ is to promote and maintain service users daily living skills, and to provide ‘pleasurable pastimes’ that are as individual, as each person living at the home. Other service users were enjoying each others company chatting and passing the time of day, a small group informed the inspector that nothing made one so happy as good company. Many of the service users 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 they were observed to be very much 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. Life history Records within care plans contained information on service users personal histories and individual hobbies and interests. Daily diaries recorded what each service user chose to do on a daily basis. Service users 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. There were many other items of interest within the lounges such as sensory displays and items of memorabilia. Outdoor activities, so beneficial to service users with Dementia needs, were restricted by the limitations of the garden area (See “Environment”). The registered manager said that the home regularly hires the village hall, which is across the road from the home, for a larger social gathering; and staff told the Inspector about a recent strawberry-picking outing. The home is aware of and responsive to service users religious needs and records showed that these well met. For example staff are advised to assist a service users to say her daily prayer, but staff beliefs are also respected in that they should speak with the Registered Manager if they are unable to do so. A visitor, and feedback forms spoke very highly of the care that service users received, saying for example that “staff care is “beyond the call of duty”, “she is invariably serene and contented, staff are very creative in meeting her needs”. The home has a flexible approach to the times of day that residents get up and go to bed; this was demonstrated in observations of the morning routines. The care plans demonstrated flexibility in accommodating the individual routines of residents. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 15 Service users were seen to be being assisted with sensitivity to eat their chosen breakfasts. Staff took time to sit with individual service users as long as was needed for them to enjoy their breakfast, and the atmosphere was relaxed and homely. 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. The Inspector had an opportunity to speak with the cook who showed a good understanding of service users individual tastes and needs. Kilsby House Residential Home DS0000012830.V340521.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. Residents and their representatives can be confident that any concerns they may have about the service will be taken seriously and acted upon. EVIDENCE: Discussion with visitors and comments on feedback cards were indicative that the good relationships that are established with service users and their relatives promote excellent communication, and pre-empt complaints being made. The home has a complaints log and one complaint was recorded therein. The Commission for Social Care Inspection had received one complaint since the last inspection taking place; this was referred back to the home for investigation. It was unclear whether the Registered Manager had received the full details of this complaint, but evident through inspection processes that any shortfalls appeared to have had been resolved. Advice was given on the best practice in relation to the management of monies held on behalf of service users and the overview of the monies that they receive. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The internal environment provides comfortable surroundings that are maintained to an acceptable standard. The garden area needs improvement. 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. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 18 All members of staff carry a key on their person. The residents’ freedom to independently move from group to group is restricted, however outside of the group units there hazards such as 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 being fully enclosed. Within the garden there were various hazardous items that looked unsightly such as old equipment that was awaiting disposal, and calor gas containers. The manager said that a grant has been received and that there are plans to completely landscape the gardens this year. The grant is said to provide sufficient funding to be able to provide a suitable environment for service users with dementia needs. 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 seen to be generally clean and homely. The Manager was advised on some matters needing attention, such as the hot water, which was found to be very hot from some taps. The Inspector was assured that service users were most unlikely to be able to access these taps without being observed by staff. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Service users are cared for by an experienced, well-trained staff team who are sensitive and responsive to their needs. EVIDENCE: At the time of the inspector’s arrival in the early morning there were six care staff on duty (two in each area) and the Registered Manager. This was sufficient to meet service users needs at that time. As the morning wore on there were difficulties in the high dependency unit in fully meeting service users needs there. The Registered Manager was advised of this. Consideration needs to be given to how this difficulty can be resolved. Records showed that staff training in all the necessary subject areas is properly prioritized and that staff are given every opportunity for professional development. Staff teams in each area were seen to be fully competent showing a pride in their work, and knowledge and interest in development. Staff employed from China and Poland come through employment agencies specialising in providing staff for the care sector. In addition to interviews Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 20 undertaken by the agencies, the Registered Manager conducts telephone interviews to ensure that staff are proficient in speaking English. The inspector was concerned that the telephone interview may not be with the person who actually takes the job. The Registered Manager was aware of the particular importance of excellent language skills with the client group for which the service is registered, and agreed the process was risky. The Registered Manager did not have evidence on the staff files, and had not seen the Criminal Record Bureau checks or references on new staff as the Registered Owner holds these. The Registered Manager was reminded of her personal accountability in respect of the day-to-day running of the home. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 21 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. Service users live in a home that promotes their rights. Management is effective and well organized. The Registered Manager keeps in close touch with her staff and service users and promotes a high quality of care. 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 Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 22 evident through discussion and review of documentation that she is very skilled, experienced and competent to manage the home. A feedback card stated that the home has “an understanding and response to people with Dementia”. There is an open and inclusive atmosphere within the home, and staff said that they feel supported. During the inspection the registered manager was observed communicating and interacting with residents and staff and visitors in a relaxed and professional way. Supervisions and 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. Health and Safety and maintenance are well monitored, and any issues arising are noted and resolved promptly. Records sampled are well maintained and give easy access to relevant information. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 23 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 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 x x 3 Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 24 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. 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 2 3 4 Refer to Standard OP9 OP18 OP19 OP29 Good Practice Recommendations Medication Administration Sheets should accurately reflect all the medications that service users are currently taking, and should always be filled in by staff. Transactions made on behalf of service users should be receipted and wherever possible double signed, to protect both service users and staff. Individual thermostatic regulator valves should be fitted to all taps that deliver very hot water in areas accessible to service users, to protect them from potential scalds. There should be evidence of a fully professional recruitment process on staff files. Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Kilsby House Residential Home DS0000012830.V340521.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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