CARE HOMES FOR OLDER PEOPLE
Kimberley Nursing Home 51-53 The Avenue Surbiton Surrey KT5 8JW Lead Inspector
Alison Ford Key Unannounced Inspection 3rd May 2006 11:00a 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 Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 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. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 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 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) 0208 390 1557 020 8390 4372 Partnership of Parkin, Blown and Blown Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability over 65 years of age of places (38) Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: 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 wellmaintained 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, 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. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of the home for the year 2006/2007 and was an unannounced visit lasting six hours. During this time a tour of the premises was undertaken and many of the residents and staff were spoken with. In addition, during the inspection process, four relatives that visit the home have been asked for their views. All of those standards considered by The Commission to be key to the inspection process have been assessed at this visit. During the last year the home has experienced a change in the management structure. The registered manager, the administrator, housekeeper and maintenance man left the home to purchase another establishment and have not, as yet, been replaced. During this time representatives of the current owners, who live in Spain, have filled the management roles. A senior nurse has overseen the clinical care assisted by the other trained nurses. They are all to be congratulated on the work that they have done to maintain the comfort of the residents and ensure their protection, health and safety. Since the last inspection one concern had been raised, by a care manager, and this was resolved promptly. The home is registered to care for thirty-eight elderly people and at the time of the inspection had one vacancy. Fees range from £585 - £600 per week although additional charges may be payable for personal items and would be discussed prior to admission. What the service does well:
Although this home still has significant shortfalls in some areas, it provides a generally safe and homely environment for its residents who were all very appreciative of the staff, many of whom have been there several years. The residents all appeared well cared for and staff were pleasant and cheerful. A range of activities is provided to interest and stimulate residents although there was some discussion as to how this might be increased. The home is staffed by a mixture of trained nurses and care staff and staffing levels are appropriate for the healthcare needs of the residents although staff training is still one area which needs to be improved on . All of those that were
Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 6 spoken to agreed how lovely the staff were and how well looked after they were. Comments were made “ that “ it is a lovely place to live ““staff are very kind and gentle” and “staff are always respectful”. Residents agreed that the food served in the home was of a high standard with choices available and it was observed that special requests were catered for without any problems. Recruitment policies and procedures are in place to help protect residents and individual care plans identify the care and support that is required by them. Everyone confirmed that should they experience any concerns or problems they were confident that they would be dealt with promptly. was What has improved since the last inspection? What they could do better:
This home has now been without a registered manager for over six months and while acknowledging the effort that has gone in to trying to recruit a suitable person this must now be addressed as a matter of priority. The senior nurse overseeing the clinical care in the home works a limited number of hours and although always available to offer advice she is unable to provide the continuity of care and leadership required to ensure best quality care for the residents. She is to be commended on her commitment to the home however many of the issues raised during this inspection would be those that would be rectified by the appointment of an appropriately qualified and experienced manager. Priority has been given to those concerns previously raised, which directly affected the wellbeing of residents. The homes Statement of Purpose and Service User Guide has not yet been updated which means that the
Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 7 information given to prospective residents and their families may not be reflective of the current situation in the home. The assessment of care plans showed limited evidence that residents were able to contribute to the planning of their care and it was also felt that more attention to their social needs would improve their lives. Risk assessments are also needed when resident’s preferences are contrary to health and safety guidelines. Medication record sheets would benefit from regular audit to monitor any errors and a new contract may need to be implemented to deal with unwanted medication, in line with current legislation. It was recommended that, although some activities are provided in the home, thought should be given to increasing them to provide more interest and stimulation for residents. Much of the home still requires redecoration and although a refurbishment programme is planned this still needs to be implemented. A staff training plan is being compiled and this now needs to be implemented with priority given to ensuring that all staff receive training in adult abuse awareness. In addition a system needs to be introduced to give residents the opportunity to comment on and influence the care and services that they are receiving. Staff meetings and supervision also need to be introduced in order that staff are given the opportunity to influence the running of the home and ensure that their training needs are met. 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 DS0000026250.V292679.R01.S.doc Version 5.1 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 Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The pre-admission assessment that is undertaken ensures that residents can be confident that their assessed health care needs will be met although the information that they receive may not reflect the current situation in the home. This home does not offer intermediate care: this standard does not apply. EVIDENCE: Previous inspections revealed that the Statement of Purpose and Service User Guide required updating to reflect the current situation in the home. This has still not been done. It is acknowledged that other issues, pertaining to the running of the home and the health and safety of residents, have taken priority however so that potential residents have access to up to date information this must now be given some consideration. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 10 The pre-admission information of a newly admitted resident was seen and this provided sufficient information to ensure that their healthcare needs would be met by the staff in the home. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 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 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 adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents have an individual plan of care and they can be confident that this reflects the current care and support the they require although more information regarding their social needs may mean that activities could be tailored to suit their interests. 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 and medication procedures are in place to protect them. EVIDENCE: Six care plans were assessed during the inspection. The Standex system is in use in the home and all sections were appropriately completed and regularly reviewed although there was limited evidence that residents had been involved in the process. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 12 There was evidence of regular assessments, which would identify those at risk of developing pressure sores, and entries that showed that advice had been received from other healthcare professionals as necessary. Work is also in progress to identify the preferences of residents regarding hospital treatment if they should become unwell and resuscitation in the event of it being appropriate. It is recommended that the Resuscitation Council should be contacted for advice on theses issues. It was felt that more detail about residents social care needs and preferences would help to plan activities that might interest them and it is recommended that some time should be spent in assessing these. Risk assessments must also be undertaken for any resident that wishes to undertake any activity in a way which deviates from accepted practice. One resident refused to have footplates fitted to her wheelchair, which could lead to a serious injury occurring, and there must be evidence that they have been made aware of this. Medication stores and records were seen. There were some omissions in the recording of medication that had been given and a senior member of staff must audit these records on a regular basis to monitor the situation. Unwanted medication is still being returned to the pharmacist. There must be evidence that they have a licence in place to do this. If not, a new contract must be set up in line with current legislation. All personal care is delivered in resident’s own rooms. Staff were observed treating residents very kindly and comments were received that “staff were very calm and kind “. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 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 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 adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Routines of daily living are made flexible and activities are provided however, they could be increased to provide more interest and stimulation for residents. 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 some 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. They said that their relatives and friends are always made welcome when they visit. Routines within the home are made as flexible as possible and residents are always able to choose what they eat and the clothes that they wear.
Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 14 On the day of the inspection it was noted that there was no organised activity. It is recommended that care staff should be encouraged to interact with residents and provide some stimulation on these occasions. Residents agreed that the food served was very good and that they are always offered a choice. There was also evidence that particular preferences are catered for. 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 DS0000026250.V292679.R01.S.doc Version 5.1 Page 15 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 poor. This judgement has been made from evidence gathered both during and before the visit to this service. Residents and relatives are sure that any concerns would be dealt with promptly although there is no way of recording issues that may have been raised. Residents cannot be sure that staff have the knowledge and training to protect them from abuse although recruitment procedures help to maintain their safety. EVIDENCE: Residents and relatives that were spoken with all confirmed that they felt confident that should they have any concerns they would be dealt with promptly by the management team. A copy of the homes complaints procedure is displayed in the hall however there is no complaints book available in the home. In order to monitor any areas of concern a complaints book must be held in the home, which includes details of the actions taken to resolve complaints and the outcomes. Recruitment procedures are robust and all staff have received clearance from The Criminal Records Bureau however have many have not attended training on issues concerned with abuse of the elderly. A training programme is currently being compiled for staff and this subject must be given some priority. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 16 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 from evidence gathered both during and before the visit to this service. Although the home is clean and tidy redecoration and refurbishment would make it a more pleasant environment for residents to live in. EVIDENCE: The majority of the home, both bedrooms and communal areas, still requires redecoration and refurbishment. Carpets are worn and shabby, wallpaper needs replacing, some ceilings need repainting. No rooms have a lockable facility for the use of the residents. Wheelchairs are still being stored in the sitting room where they could pose a safety hazard to residents and staff. Issues relating to the health and safety of residents have been given priority and automatic door closers, which operate in the event of a fire, have now fitted to the bedroom doors of those residents wishing to keep them open. Window restrictors have also been repaired.
Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 17 The homes representatives are negotiating timescales to undertake the refurbishment of the home and the Registered Providers must now supply The Commission for Social Care Inspection with timetable outlining how this will be achieved. On the day of the inspection the home was clean and tidy and free from odour and recent training has been undertaken in infection control for the majority of staff. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 18 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 adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents can feel confident that there will be sufficient staff on duty to care for them although they would benefit from further training to ensure their needs can be met. Residents can be sure that they will be protected by the homes robust recruitment procedures. EVIDENCE: Previous inspections resulted in changes to staffing numbers and on the day of the visit there were sufficient staff on duty to care for residents. Rotas have been altered again to maintain this level of care and the situation will continue to be monitored. Training schedules for staff are being complied and 3 have already undertaken an NVQ qualification at level 3. Other will be starting at level 2. Some further training has started The Commission must now be supplied with a plan outlining how this will continue and include all statutory training. Files of four staff members were assessed and showed evidence of robust recruitment procedures and induction training for new staff. All necessary checks had been obtained on staff prior to their employment.
Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 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): 31,33,35,36,38 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a home, which is without a suitably qualified and experienced manager who will safeguard their interests and they are unable to contribute to the running of the home. Residents can be reassured that the home is financially viable and that they will be able to remain there a long as they need to and there are measures in place to ensure their health and safety. EVIDENCE: The home has been without a registered manager for some time although it is acknowledged that strenuous efforts have been made to recruit a suitable person. The Registered Providers must supply The Commission for Social Care Inspection with details of how they intend to rectify this situation.
Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 20 There are currently limited opportunities for residents, relatives or staff to contribute to the running of the home via a quality assurance programme or staff meetings. The senior nurse on duty at the time of the inspection agreed to inform relatives of the inspection that had taken place and how they could access the ensuing report. The Registered Providers must provide details of how they will seek the views of those using the service to ensure that it meets their needs. It is recommended that regular staff meetings take place in the home so that all staff are aware of what is happening and have the opportunity to contribute their views. The lack of a manager has meant that staff supervision is not occurring in the home for care staff. The Registered Providers must provide details of how this will be undertaken. Certificates of worthiness were not available at this visit, as they had been kept by the maintenance man who had recently left the home. They had previously been in order and will be checked at a future visit. Staff confirmed that there had been regular fire training, and visits have been undertaken by the fire safety officer and food hygiene inspector within the last six months and any issues complied with. The accident book was seen and all recorded incidents had been minor. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 2 1 2 Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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. (Previous timescale 30/03/06 not met) The Registered Provider must ensure that care plans reflect residents social care needs and preferences. The Registered Provider must ensure that risk assessments are compiled where residents wish to undertake an activity that may not be inline with good health and safety practices The Registered Provider must ensure that an appropriate method is in place to deal with the disposal of unwanted medication. The Registered Provider must ensure that there is a record in the home of all complaints made which includes details of any
DS0000026250.V292679.R01.S.doc Timescale for action 30/08/06 2 OP7 16(2)(m) 30/08/06 3 OP7 13(4)(c) 30/08/06 4 OP9 13 (2 ) 30/08/06 5 OP16 Schedule4 30/08/06 Kimberley Nursing Home Version 5.1 Page 23 6 OP18 13(6) 7 OP19 23 (2) (b) (d) action taken and the outcome. The Registered Provider must submit an action plan outlining how care staff will receive training in issues concerning adult abuse The Registered Provider must ensure that there is a programme of maintenance and redecoration of the home and that a copy of this is sent to the office of The Commission for Social Care Inspection. (Previous timescale 30/03/06 not met) 30/08/06 30/08/06 8 OP22 13(4) (c) The Registered Provider must ensure that suitable storage facilities are available for wheelchairs. (Previous timescale 30/03/06 not met) 30/08/06 9 OP30 18(1)(c) 10 OP31 8(1)(a) 11 OP33 12(2) 12 OP36 18(2) The Registered Provider must submit an action plan outlining how staff will receive training appropriate to the work that they do. The Registered Provider must submit an application to register a suitable person to manage the home. The Registered Provider must submit an action plan outlining how they will gather the views of the people who use their service. The Registered Provider must submit an action plan detailing how care staff will receive supervision sessions at least six times a year. 30/08/06 30/08/06 30/08/06 30/08/06 Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 24 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 5 Refer to Standard OP7 OP7 OP9 OP12 OP36 Good Practice Recommendations It is recommended that there should be evidence that residents have participated in the compilation of their care plans. It is recommended that guidance should be sought from the Resuscitation Council about introducing relevant policies and procedures into the home. It is recommended that MAR sheets should be audited on a regular basis to monitor any mistakes in recording. It is recommended that care staff should undertake additional activities with residents when no structured sessions or entertainment is planned. It is recommended that regular staff meetings are held in the home to allow all staff to contribute to its running. Kimberley Nursing Home DS0000026250.V292679.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston 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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