Inspection on 14/07/09 for Kimberley Nursing Home

This inspection was carried out on 14th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kimberley Nursing Home 15/07/08

Kimberley Nursing Home 30/07/07

Kimberley Nursing Home 03/05/06

Kimberley Nursing Home 05/01/06

Kimberley Nursing Home 21/09/05

Kimberley Nursing Home 01/03/05

Kimberley Nursing Home 13/08/04

Kimberley Nursing Home 27/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kimberley Nursing Home 51-53 The Avenue Surbiton Surrey KT5 8JW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Ford     Date: 1 4 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Kimberley Nursing Home 51-53 The Avenue Surbiton Surrey KT5 8JW 02083901557 02083904372 kimberleynursinghome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Partnership of Parkin, Blown and Blown care home 38 Number of places (if applicable): Under 65 Over 65 38 38 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 Kimberley Nursing Home is registered with The Commission for Social Care Inspection to provide nursing care for up to thirty-eight older people. Accommodation is arranged in a mixture of single and shared rooms over three floors. There is a large lounge and dining room and an attractive well-maintained rear garden, which is well used by the residents. All areas of the home are accessible to residents, including those who may have limited mobility, there are both a passenger lift and stairlift in place. The home is situated in a quiet residential road in Surbiton and there is off street parking to the front of the property. Fees at the time if this inspection range from £473.45 to £800 according to the room and the dependency of the resident and would be discussed prior to admission. There may be different charges payable for those who are funding their own placements as Care Homes for Older People Page 4 of 28 Brief description of the care home opposed to those who are admitted under care management arrangements. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report follows an unannounced visit to the service made as part of the inspection process for this year. We last visited the home on th July 2008. When writing the report we have also taken into consideration other information that we have been given throughout the year, such as records of accidents, complaints, and documentation that is required to be kept by the home. In addition the home sent us their Annual Quality Assurance Assessment (AQAA). This is a self assessment in which the home tells us how well they believe they are meeting their aims and objectives and about their plans for the future. On the day that we visited we undertook a tour of the home and spoke with many of Care Homes for Older People Page 6 of 28 the residents , to try and find out what it is like for them to live there. We also spoke with some relatives and members of staff who were on duty. We looked at a sample of care plans and also to other documentation that the home is required to keep as evidence of its commitment to the health and safety of the people who live there. Since our last inspection The Commission has not received any complaints about this service. What the care home does well: What has improved since the last inspection? What they could do better: The AQAA that we received from the home shows that they are aware of some of the areas where further improvements could be made. More redecoration and refurbishment is planned for the future including the exterior of the home and replacement windows. Training for staff is also an area where they hope to improve over the coming year with extra sessions for staff designed to help them understand more about the people that they are caring for. The satisfaction surveys that were returned highlighted the fact that people would appreciate even more activities and possibly trips out of the home to add interest and Care Homes for Older People Page 8 of 28 stimulation to their days. When we looked at residents care plans we found that some of the information that we would have expected to see was not there. We have made some requirements about the need for better pre-admission assessments so that the home can be sure that placements will be suitable and the daily life in the home will meet residents needs and expectations. We have also asked them to ensure that care plans are drawn up with involvement from the resident or their relative so that residents are able to influence the way that care is provided and they can be sure that they are being supported in the way which they prefer. There is also a need to show how identified risk factors in relation to the development of pressure sores are going to be managed to minimise any risk of this occurring. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those people who are admitted via the local authority have had assessments undertaken to ensure the home will be suitable for their needs however, the homes own assessment procedure must be improved in order to avoid unsuitable placements. The home is not registered to provide intermediate care. Evidence: The home has recently produced a new Statement of Purpose and Service User Guide. These are clear and informative, outline the aims of the home and give residents and their families all of the information that they might need. They comply with the regulations and copies will be put into residents rooms to replace those currently there. Those residents that are admitted through Care Management arrangements have an Care Homes for Older People Page 11 of 28 Evidence: assessment that has been carried out according to local authority guidelines. We were told that they also have an assessment, undertaken by a senior nurse, to ensure that the home will be suitable for their needs. However, we looked at the one that had been produced for a person who had recently been admitted and there was very little useful information on it. When we spoke with the resident they told us Im quite happy here but a bit bored. None of the pre-admission information had looked at how they might want to spend their time during the day and whether the daily routine of the home would suit them. In order to ensure that unsuitable placements are, wherever possible, avoided and daily life in the home will suit people considering moving in, this assessment must be more detailed. Potential residents and their families would be encouraged to visit the home before moving, in if they were able, and sometimes they are able to have a choice of room,depending on availability. Placements are only made permanent following a review to make sure that people are happy with the arrangements. The home is not registered to provide intermediate care which would require an additional staff team and rehabilitation resources. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People say that they are cared for in a way which suits them however, the documentary evidence to support this is not always in place. Evidence: People told us that they are cared for in a way which suits them, and we saw that each resident has an individual care plan. These should identify the areas where people need help and support and provide the evidence of the care that is being given. During the inspection process we looked at four of them. When we looked at them we found that some of the information that we would have expected to see was not in place. One resident, that we had spoken with during our visit, had been able to tell us a lot about her previous life, occupation and interests however, staff had not recorded any of this or anything about how she would like to spend her days. Gaining this knowledge helps staff to interact with the people that they support and understand them. It also allows activities to be organised which will interest them. Care Homes for Older People Page 13 of 28 Evidence: None of the care plans we looked at had been signed by the resident or their relatives to indicate that they had been able to contribute to them or to influence the way that they would like to be supported. For people who need to be moved using a hoist there was limited information available about the type of hoist or sling which should be used. This should be in place to ensure that all staff are using the same techniques although we did see that there is a notice on the wall explaining what should be used. Factors which might predispose to the occurrence of pressure sores,such as skin integrity and nutritional status were being monitored. However there was no overarching plan about how the risk factors should be managed so that pressure sores did not occur.We also noted that one resident had been assessed as being at high risk of developing pressure sores and was complaining about being uncomfortable but no pressure relieving equipment was being used on her chair. We saw that other health care professionals are consulted where appropriate such as the chiropodist and tissue viability nurse and residents are able to access a doctor whenever it is necessary. We looked the medication procedures in the home and generally they were well organised. However, when medication is ordered at the beginning of a cycle it is not always clear how much was left from the previous month. We have asked the home to ensure that this is made clear so that we can do a comprehensive audit. We were told that regular checks of the medication are undertaken although the nurse in charge at the time was not able to find the evidence of this. We saw that people were treated with dignity and respect, staff were very kind in their approach and residents told us that they were lovely and do all that they can to help you. All personal care is carried out in residents rooms and if they wanted to meet with their relatives in private they are able to go and sit in the dining room or their own bedrooms. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home generally find that the daily life there suits their needs and capabilities. Evidence: The overall atmosphere within the home is very welcoming and cheerful and the majority of people who live there told us that it suits them although one lady said it is a bit boring . The management team are aware of the need to continue to increase the activities available for residents and are buying more games and craft items to help with this. They are also looking at the possibility of residents being able to help in the kitchen with food preparation. There is an activities organiser twice a week and we saw that care staff spend time with residents as well, playing games or just sitting talking with them. Outside entertainers visit the home on a regular basis. Relatives and friends are always welcome to visit and those that we spoke with told us that staff are always very welcoming to them. Birthdays and other significant occasions are always celebrated. Residents have been encouraged to bring possessions from home in with them to Care Homes for Older People Page 15 of 28 Evidence: make their bedrooms more personalised, such as pictures and ornaments and one lady has two budgies in their room as well. People told us that they are free to choose how they spend their days and are able to decide when they want to get up in the morning and go back to bed. They were very complimentary about the meals in the home and told us that there always alternative dishes available. One lady is a vegetarian and she told us that Its never a problem, I always get something nice and other preferences or special diets can always be accommodated. The home tells us that they would also help residents who wanted a take away. We were told that breakfast is particularly good with a cooked meal always being available. One lady complained about how it was making her put on weight! Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are confident that any concerns that they might raise would be dealt with promptly. There are procedures in place to ensure that any suspicion or evidence of abuse would be addressed however, pre-employment checks which ensure residents protection are not always completed appropriately. Evidence: There is a complaints procedure in place and copies are in the Service User Guide which is in the bedrooms of all the residents. It is recommended that a copy should also be displayed in the entrance hall. People that we spoke with said that they didnt ever need to complain but if they did they were sure that staff would make sure any concerns were dealt with. The AQAA tells us that the home would view any complaints as feedback and a positive process which would help them improve their service. Staff displayed an awareness of the principles of recognising and reporting any suspected abuse and they have all received recent training relating to this. All staff have had clearance from the Criminal Records Bureau although subsequent examination of staff files showed that the relevant checks are not always completed prior to their employment. The Responsible Person was reminded of their responsibilities with regard to this. Care Homes for Older People Page 17 of 28 Evidence: No complaints have been received about the service since our last visit. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable and meets the needs of the people who live there. The management team are aware of the improvements that still need to be made. Evidence: As a part of the inspection we walked around the home and looked at the communal areas, bathroom and toilet facilities and some of the residents bedrooms. The home was clean and warm and free from any unpleasant smells. Residents bedrooms are comfortable and many have been personalised with items from home such as pictures, ornaments and small items of furniture. There are aids and adaptations throughout the home to help those with limited mobility and both a passenger and stairlift are in place. The rear garden is ramped so that it can be enjoyed by residents who rely on wheelchairs and there are plenty of colourful shrubs and flowers. Spare wheelchairs are now stored in a covered shelter in the garden when not in use. We did see that there is some old and unwanted equipment lying around out there but were told that there are plans to have this removed. Since the inspection we have been told that this has been done. Some redecoration and refurbishment has been undertaken however, there is still some way to go to ensure that the home reaches the standard we would expect to Care Homes for Older People Page 19 of 28 Evidence: see. Over the last year the kitchen has been refitted and much of the home has been recarpeted. Prior to that the nurse call system and the fire alarms were renewed.Communal areas and some bedrooms have been repainted. The responsible person for the home is aware of the work that still needs to be done and there are plans to replace widows, decorate the exterior of the home and to upgrade bathrooms and toilets. As bedrooms become vacant these will be repainted and refurbished as necessary. The laundry area is in the process of being upgraded and the new flooring is about to be laid.We are told that, since the inspection, this has been done Equipment to minimise the risk of cross infection such as disposable gloves and aprons is freely available. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet the needs of the residents however, there must be evidence in place to show that pre-employment checks have been completed prior to new members of staff beginning work in the home. Evidence: The home is staffed by both trained nurses and carers , supported by domestic and ancillary staff. On the day we visited there were enough staff on duty to meet the needs of the people who live there and the rotas showed that this was generally the case. People told us that the staff always come if they call or ring their bells and that they do not have to wait very long for them. They told us staff are very kind one lady said they cant do enough for you. and another you cant fault the staff here, theyre wonderful. When we spoke with them we found them very pleasant and receptive to the inspection process. Staff training has improved since our last inspection. More than 50 care staff have achieved an NVQ to at least level 2 and in house training has included moving and handling, fire safety, The Mental Capacity Act and Deprivation of Liberties Safeguarding. New staff were able to tell us about the induction programme that they had undertaken. The AQAA tells us that training is still an area where the home is hoping to improve. They also intend to produce a matrix highlighting exactly which Care Homes for Older People Page 21 of 28 Evidence: member of staff has attended each training session. We looked at the staff files of some of the people employed since our last visit. Although appropriate clearance from The Criminal Records Bureau and Protection of Vulnerable Adults register was now in place there was no evidence available to show that this had been gained prior to employment. These checks are in place to ensure that those who have been judged as being unsuitable to work with vulnerable people are prevented from doing so and the Responsible Person is reminded of his responsibilities with regard to this process.Other information required to be obtained was all in place. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people that live there and working procedures help to ensure that their health and safety are protected. Evidence: There is currently no registered manager in post in the home and the responsible person is attempting to address this situation. The senior nurses have all been working at the home for some time and are able to provide guidance for care staff. Since the last inspection, quality surveys have been distributed to residents and their relatives to try and measure whether the service is meeting their needs. These are in the process of being collated however, results so far have been very positive. Generally people are happy with the way that the home is run although some have indicated that they would like to see more activities organised for them to join in with. Residents often talk with the responsible person for the home who is frequently walking around, and he tries to act on any suggestions that they make. Care Homes for Older People Page 23 of 28 Evidence: No money is kept on behalf of any of the residents. They all have relatives or advocates to deal with their financial affairs. The information that we have from the home tells us that equipment and services are being appropriately maintained. We are always informed of any incidents that occur and policies and procedures designed to protect the health and safety of residents and staff are all in place. The last kitchen inspection resulted in a score of 3 stars from the environmental health officer. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Pre-admission assessments 30/09/2009 must provide evidence to show that consideration has been given to the needs and preferences of potential residents. So that they can be sure that the home will meet their needs and the daily life there will suit them. 2 7 15 Unless it is impractical to do 20/09/2009 so care plans must be drawn up with the involvement of residents or their relatives. So that they are able to influence the way that care is provided and be sure that it will meet their needs. 3 8 12 Care plans must be reflective of all of the care and support that is needed by residents. In order to ensure that their health care needs are being met. 20/09/2009 Care Homes for Older People Page 26 of 28 4 8 12 Appropriate pressure 20/09/2009 relieving equipment must be in place for any one who has been assessed as requiring it. To help prevent the incidence of pressure sores occurring. 5 26 19 There must be evidence that 30/07/2009 pre-employment checks have been completed prior to new members of staff starting work in the home. So that people are protected from those thought o be unsuitable to be working with vulnerable adults. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 It is recommended that, when medication has not been ordered, there should be an indication of how much is remaining in order to ensure a complete audit trail is possible. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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