CARE HOMES FOR OLDER PEOPLE
Kimberley Nursing Home 51-53 The Avenue Surbiton Surrey KT5 8JW Lead Inspector
Alison Ford Unannounced 21 September 2005 10:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Kimberley Nursing Home Address 51-53 The Avenue, Surbiton, Surrey, KT5 8JW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8390 1557 020 8390 4372 Partnership of Parkin, Blown and Blown Mrs Tracey OShea Care Home 38 Category(ies) of OP Old Age (38) registration, with number of places PD(E) Physical Disability - over 65 (38) Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1 March 2005 Brief Description of the Service: Kimberley is registered with The Commission for Social Care Inspection to provide nursing care for up to thirty eight older people. Accomodation 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 acessible to residents, including those who may have limited mobilty, and a passenger lift,specialist adaptations and equipment have been provided. The home is situated in a quiet residential road in Surbiton and there is off street parking to the front of the property. There is currently some ongoing discussion ocuring about the future ownership and management of the home, as the owners are no longer living in England, and it is hoped that this will be resolved in the near future. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours and included a partial tour of the premises and an assessment of a sample of care plans and staff files .The inspection was conducted with the homes manager and administrator who are thanked for their help and hospitality. There was also some discussion with the accountant who is currently representing the owners who live abroad. During the visit fifteen residents and two relatives, who were visiting, were spoken to and also three staff members. Two anonymous complaints had recently been received by the commission, one regarding staffing levels and the other about financial concerns. These issues were addressed during the inspection. What the service does well: What has improved since the last inspection?
Since the last inspection, the manager of the home has introduced staff supervision and has managed to send some of the staff on various training sessions. This will need to be expanded upon to meet the requirements of 50 care staff educated to NVQ level 2 standard. Staffing levels in the home have recently been increased although they still do not comply with the originally issued notices and this must be addressed without delay.
Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 6 Care plans have now been updated and are regularly reviewed to ensure that they accurately reflect the care and support that is currently being delivered. Radiators in bedrooms have now been covered and carpets have been replaced as was previously required at 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. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,6 The comprehensive pre-admission assessment process ensures that residents can be confident that the home will meet their assessed healthcare needs and that it is suitable for them however, the service user guide still needs to be updated. This home does not offer intermediate care. EVIDENCE: The sample of care plans, that were assessed, showed that a comprehensive pre-admission assessment had been undertaken which looked at all aspects of the residents healthcare and psychosocial needs. These then form the basis for subsequent care planning and there was evidence of how well the health of some of the residents had improved since their admission. Some residents had been able to visit the home prior to their admission however their frailty often meant that this was not feasible. The service user guide that is currently being used is out of date and does not contain all of the requirements of the minimum standards and must be updated. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Individual care plans reflect the care that is currently being given and are reviewed regularly so that residents can be confident that staff are aware of their needs and the support that they require. The arrangements that are in place for delivering personal care ensure that residents can be sure that their dignity and privacy will always be respected. EVIDENCE: Four care plans were assessed and found to be in good order. Both trained nurses and the carers are able to contribute to these plans and they are regularly reviewed by the manager. Equipment to treat and prevent pressure sores was seen throughout the home and assessments are made monthly to highlight those who may be at risk. There was clear evidence that the health and mobility of several of the residents had improved since their admission and photographs were seen that monitored the improvements made in relation to pressure sores and wound healing. Nutritional scoring is undertaken and resident’s bodyweights are checked monthly. Visits by the GP and other specialists are recorded and the majority of the residents are registered with the same medical practice. Staff were observed treating residents with respect and dignity and residents confirmed that this was always so. All personal care is undertaken in resident’s rooms and screening is provided in shared rooms. Medication records and
Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 10 storage were not assessed at this visit however, the homes manager was reminded that new legislation has been introduced concerning the disposal of medication and this will need to be implemented. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 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 standard(s) 12,13,14,15 Activities within the home are organised in a way that suits the residents and visitors are always made welcome so that relationships can be maintained. Meals are served that are suitable and nutritious and so maintain the health and wellbeing of residents. EVIDENCE: Residents confirmed that activities are provided which suit their needs and they are able to choose whether they wish to participate. Some explained that they prefer to remain in their rooms and watch television or read. Relatives and friends are always welcome and are able to bring pets in with them and church representatives also visit the home. The lunchtime meal was observed during the inspection and was well presented. Residents agreed that the food served was very good; they are visited by the housekeeper in the morning, and informed of the meals that will be served and offered a choice. Most of the residents eat together in the dining room although they are able to stay in their rooms if they wish to. A tour of the home illustrated that residents have been able to bring personal possessions in with them from home. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 There is a clear complaints procedure available so that residents are aware of the procedures that are to be followed and appropriate procedures are in place to safeguard them from abuse. EVIDENCE: A copy of the complaints procedure is available in the hall of the home and some of the residents that were spoken to confirmed that they were confident that any concerns would be dealt with appropriately, by the manager of the home. The Commission had received two complaints about the home recently, which were discussed, and both of these had been resolved. The staff, that were spoken to, displayed an understanding of adult abuse and the procedures to be followed and all staff have received satisfactory clearance from The Criminal Records Bureau. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,22,24,26 Although it is clean, a programme of redecoration and refurbishment would make the home a more pleasant environment for residents to live in. An absence of call bells in some bedrooms means that residents are not always able to obtain assistance when necessary and a lack of storage space could lead to a potentially hazardous situation occurring. EVIDENCE: The majority of the home, both bedrooms and communal areas, requires redecoration and refurbishment. Carpets are worn and shabby, wallpaper needs replacing, some ceilings need repainting. Window restrictors are still absent in some rooms and none of them have a lockable facility. Automatic door closers, which operate in the event of a fire, need to be fitted to the bedroom doors of those residents wishing to keep them open. Two bedrooms have been decorated since the last inspection and are very attractively presented although one has since suffered some water damage to the ceiling. Tiles in the kitchen need to be replaced and flooring in the dining room needs repairing. An action plan must be provided to show how these issues will be dealt with.
Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 14 The laundry area is small for the size of the home however it is tidy and appropriately equipped. A cupboard in the hall, which contains cleaning materials, was open and overfull this must be kept locked. Adaptations have been made throughout the home to help residents however it was noted that several call bells were missing from bedrooms. The manager was asked to rectify this as soon as possible to ensure that residents were able to summon help if it was required. Wheelchairs are still being stored in the sitting room despite a previous recommendation that an alternative storage area should be found for them. This is unsightly and potentially hazardous and they must now be removed. Several wheelchair footplates were also seen lying around the home; the manager must ensure that all wheelchairs have these fitted. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 There are not always sufficient staff on duty to meet the needs of the residents and although some training is in place this needs to be increased to ensure that staff are suitably qualified for the work that they are undertaking. Robust recruitment procedures are in place to ensure that residents are protected. EVIDENCE: Although staffing numbers have apparently just been increased they are still not in line with previously set staffing notices. There were particular concerns with regard to night times. The layout of the home means that some residents will undoubtedly be left unsupervised at times. If the management team considers that original staffing levels are unrealistic they must apply to The Commission to have them amended. Until that time they must ensure that they are adhered to. Some staff training has occurred since the last inspection, however the home still will not meet the requirement for 50 of care staff to be educated to NVQ level2 standard this year. The Registered Provider must submit an action plan detailing how this will be achieved as soon as possible. Samples of staff files showed that the recruitment policies were appropriate and comply with the minimum standards. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 38 The lack of an available business and financial plan for the home means that the financial viability of the home cannot be guaranteed. EVIDENCE: Despite a previous requirement there was no business and financial plan available for the home to illustrate financial viability. An anonymous complaint had suggested that the home had been experiencing some financial difficulties and the lack of recent investment in the property could support this view. Following discussions with the accountant, acting as the representative for the Registered Providers, an appointment was made for the relevant documentation to be brought into the Commissions office. No certificate was available to show that water has been tested to show the absence of legionella; this must be obtained and a copy sent to The Commissions office. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x 2 x 2 x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x 2 x x x x Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 18 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1) Requirement The Registered Provider must ensure that the service user guide is updated to reflect the current situation in the home and that it contains all of the information as specified in Regulation 5. The Registered Provider must ensure that there is a programme of mainatainace and redecoration of the home and that a copy of this is sent to the office of The Commission for Social Care Inspection. The Registered Provider must ensure that bedroom windows are fitted with appropriate restrictors. Timescale for action 1/12/05 ( previous timescale 1/9/04 not met ) 1/12/05 2. OP19 23 (2) (b) (d) 3. OP25 12(1)(a) 4. OP`19 5. 6. 7. OP19 OP19 OP26 The Registered Provider must ensure that devices are fitted to bedroom doors which cause them to close automatically in the event of a fire. 23 (2) (b) The Registered Provider must ensure that kitchen tiles are repaired or replaced. 23(2)(b) The Registered Provider must ensure that the dining room floor is repaired or replaced. 13(4) ( c ) The Registered Manager must
G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc 13(4)( c ) 1/12/05 ( Previous timescale 1/5/05 not met ) 1/12/05 1/12/05 1/12/05 Following
Page 19 Kimberley Nursing Home Version 1.40 8. OP22 9. OP22 10. OP22 11. OP27 12. OP28 13. OP34 14. OP25 this inspection 21/9/05 and henceforth. 13(4) (c ) The Registered Manager must Following ensure thatcall bells are available this in all residents bedrooms. inspection 21/9/05 and henceforth. 13(4) ( c ) The Registered Provider must 1/12/05 ensure that suitable storage facilities are available for wheelchairs. 13(4) (c ) The Registered Manager must Following ensure that all wheelchairs are this fitted with appropriate inspection footplates. 21/9/05 and henceforth. 18(1)(a) The Registered Provider must Following ensure that stafing levels comply this inspection with staffing notices that were previously set. 21/9/05 and henceforth. 18(1)(a) The Registered Provider must 1/12/05 submit plans outlining how at ( Previous least 50 of care staff will timescale obtain an NVQlevel 2 1/6/05 not qualification. met ) 25 (2) The Registered Provider must 7/10/05 make available for inspection a business and financial plan which provides evidence of the financial viability of the home. 13(1)(c ) The Registered Provider must 1/12/05 produce evidence that water (Previous supplies within the home have timescale been tested to show the of 1/5/05 not legionella. met ) ensure that the cupboard containing cleaning materials is kept locked. Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Kimberley Nursing Home G53-G53 S26250 KimberleyUI V236422 210905 Stage0.doc Version 1.40 Page 21 Commission for Social Care Inspection Croydon, Kingston & Sutton Office 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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