CARE HOMES FOR OLDER PEOPLE
Kimberley Nursing Home 51-53 The Avenue Surbiton Surrey KT5 8JW Lead Inspector
Alison Ford Key Unannounced Inspection 30th July 2007 09:30 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.V346541.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. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 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 Post Vacant 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.V346541.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd May 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. Fees at the time if this inspection range from £500-£800 according to the dependency of the resident and would be discussed prior to admission. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first key inspection visit as part of the inspection process for the year 2007/2008 and was unannounced. When writing the report consideration has also been given to other information gathered throughout the year such as, records of accidents and complaints and other documentation required to be kept by the home. There have also been conversations with residents, their relatives and members of staff. Prior to this visit, the homes acting manager had submitted a pre-inspection questionnaire supplying information about the home. Comment cards routinely sent out, by The Commission, had also been received from residents and relatives. These generally reflected positive outcomes for the people using this service and comments were made regarding how kind and helpful staff were in the home. The acting manager, a trained nurse, will be attending for an interview with The Commission in the near future for registration. On the day of the visit there were 35 residents living in the home. In addition to the manager, two trained nurses were on duty with five care staff, supported by a cook, and domestic staff. During the visit, a partial tour of the premises was undertaken; a sample of care plans were assessed, documentation relating to health and safety was seen and several of the residents and three relatives, who were visiting, were spoken with. One anonymous complaint has been received about this service since the last inspection, which was unsubstantiated, and there was one other issue, which was managed by the local authority, with no concerns raised about the home. There have also been ongoing problems due to the breakdown of the lift. This has lead to residents not being able to come down into the lounge and although measures were introduced to try and minimise the effects there have inevitably been some concerns raised. At the time of the inspection the lift was working however further disruption will be experienced later in the year when more work will need to be carried out. What the service does well:
Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 6 Although this home still has shortfalls in some areas, mainly with regard to decoration and refurbishment it provides a 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 limited range of activities is provided to offer residents interest and stimulation 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. All of those that were 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 polite ”. They particularly said how “lovely the new matron was “ and “that they always had a laugh with her” 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. What has improved since the last inspection?
Since the last inspection the acting manageer has been working hard to address the issues that were raised at previous inspections. In order to make sure that people who use this service are able to access all of the information that they need to help them choose whether it will suit them the Service User Guide and Statement of Purpose have been developed and copies are in each residents bedroom. Minor amendments now need to be made to these, in line with the regulations, and they would benefit from being produced in a format, which would make them easier for the people who will be using them to understand. Medication procedures have been improved and no errors were noted in the sample that was seen. These are now audited on a regular basis. Concerns and complaints are now properly recorded along with any action taken to respond to them and the outcomes. Staff training is being planned and supervision has been implemented to monitor staff performance and identify any particular training needs that they might have.
Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 7 A quality assurance programme is being introduced. Questionnaires and regular meetings give residents and their relatives the opportunity to comment on the care and services provided by the home and influence any future plans. Policies and procedures within the home have all been updated and there is evidence available to show that staff have read and understood them. A new nurse call system has recently been installed in the home. 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.
Kimberley Nursing Home DS0000026250.V346541.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 Kimberley Nursing Home DS0000026250.V346541.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): Standards1, 3,6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service say that they were able to access information to help them decide whether the home would suit them and a pre-admission assessment is undertaken to ensure that their health care needs can be met. 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 now been done and copies are in the bedrooms of all of the residents. While this provides much of the information that might help residents to understand about the care and services that are provided some amendments still need to be made to them to comply with the standards. They would also
Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 10 benefit from being produced in a format that would more suitable for their capabilities Care plans provided evidence of pre-admission assessments. However, although healthcare needs had been identified there was limited information regarding social needs or preferences. Without this information the home cannot be confident that it can provide the best possible environment for prospective residents or that the life in the home and activities that are offered to them will suit their preferences and expectations. People who were spoken with during the inspection visit agreed that they had been able to access all of the information that they had needed. Kimberley Nursing Home DS0000026250.V346541.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): Standards 7,8,9,10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service have an individual plan of care however; these do not always reflect all of the current care and support that they require. More information regarding their social needs would 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: Five care plans were assessed during the inspection. Although identified problems are signed as being regularly reviewed it was not always evident that due consideration had been given to them. Also changing needs were not
Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 12 always identified. Staff would benefit from training in care planning and this has been arranged for the future. All of those residents that were spoken to agreed that they felt that their healthcare needs were being met in the way that they preferred and appropriate equipment is in place throughout the home to promote continence and prevent pressure sores. Concerns were raised about the lack of footplates on wheelchairs and this must be addressed in an effort to maintain the safety of those who use them. A sample of medication stores and records were seen and these were in order. It was noted that an external preparation, without a residents name on, was being stored in the bathroom. Products such as these must be individually prescribed and stored in resident’s own bedrooms. All personal care is delivered in resident’s own rooms. Staff were seen treating residents very kindly and residents said, “staff were very calm and kind “. Kimberley Nursing Home DS0000026250.V346541.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): Standards12, 13,14,15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service say that the routines of daily living are made flexible and limited activities are provided however, they would like them to be increased. They agree that their visitors are always made welcome. Residents enjoy the meals that are served and they are suitable and nutritious. EVIDENCE: There is limited information available to show that residents social needs and preferences have been considered however, work is now beginning on “life histories”. By recognising past lives and achievements it will be possible to begin to understand present behaviour and promote activities which will add interest and stimulation to their daily lives. Some residents commented that they would like more structured activities to be provided and this was also reflected in the pre-inspection comment cards and satisfaction questionnaire that are sent out. More bingo sessions and exercise were mentioned in particular. 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.
Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 14 Residents agreed that the food served in the home was very good and that they are always offered a choice. There was also evidence that particular preferences and diets 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. The menus were seen although these are currently being updated. A tour of the home illustrated that residents have been able to bring personal possessions in with them from home to make their own rooms more personalised. Those resident that were spoken with agreed that they were able to exercise choices in their daily lives and that their visitors, including pets, were always welcome. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service say that they are sure that any concerns would be dealt with promptly. Staff have the knowledge and training to protect them from abuse. EVIDENCE: There is a complaints procedure within the home that meets the National Minimum Standards and regulations. This is included in the documentation that is in resident’s bedrooms however; it is not currently available in any alternative formats. Everyone who was spoken with said that they thought that any complaints would be dealt with promptly although they were not always aware of the procedures that could be followed. Complaints are now properly recorded in a book with the actions taken to resolve them and any outcomes arising from them. Staff that were spoken with displayed an understanding of procedures to be followed to ensure the safety of the people who use the service. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service live in a home, which is clean and tidy however redecoration and refurbishment would make it a more pleasant environment for them. EVIDENCE: The home provides a physical environment, which is generally suitable for the people who use the service. It is clean and comfortable however much of it would benefit from redecoration and refurbishment. This view was also held by some of the people who returned completed quality assurance questionnaires. Carpets throughout the home are worn and wallpaper and paintwork is torn and chipped in places. It is acknowledged that issues of health and safety have been prioritised up to now and this work remains to be done.
Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 17 There is a pleasant well-maintained garden to the rear of the home and residents that were spoken to were looking forward to sitting out there when the weather improves. A fire risk assessment has recently been undertaken and the premises comply with current legislation and a new nurse call system has been installed. A recent inspection of the kitchen area resulted in several recommendations being made and a new kitchen is currently being planned. Consideration still needs to be given to storage within the home. It was noted that unwanted equipment is being stored in resident’s bedrooms and there are still wheelchairs, a pile of footplates and other articles in the lounge. On the day of the inspection the home was clean and tidy and free from odour. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards27, 28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use this service say that there are generally enough staff on duty to care for them and further training is being introduced to ensure their needs will always be met. They can feel confident that they will be protected by the homes recruitment procedures. EVIDENCE: On the day of the visit there were sufficient staff on duty to care for residents. An anonymous complaint had previously been made to The Commission suggesting that there had been falsification of duty rotas however an electronic “clocking in system “ is in place and this allegation was not substantiated. There has been a limited amount of training undertaken by staff to date however further training for is now being arranged and training schedules are being compiled. More staff members are being encouraged to undertake an NVQ qualification and this will be monitored at future visits. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 19 Files of four staff members were assessed and showed that all necessary checks had been obtained prior to their employment. It was however noted that there were no copies of their job descriptions or their contracts in these files. It is recommended that these should be included there. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 20 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): Standards 31,33,35,36,38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service consider that this home is run by a person who is competent to do so and in their best interests. Staff supervision is now being undertaken to monitor performance and training needs. Adequate procedures are generally in place to safeguard the health and safety of residents and staff. EVIDENCE: The Acting manager is awaiting her interview with The Commission to assess her suitability to run the home. She has many years experience in this field and has been registered to manage another home in the past. Since being employed she has worked hard to implement policies and procedures in line
Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 21 with the Minimum Standards and also to begin to involve residents and their relatives in the running of the home by gaining their views. Relatives meetings are now being held and those residents who are able to join in are encouraged to attend as well. Questionnaires have been sent out and the results will be collated. Feedback is also sought from people at the time of their initial enquiries to try and monitor their views about the help and information that they were given at that time. It is acknowledged that the representatives of the owners of the home spend a lot of time in the home and monitor its daily running. There must now be evidence that someone, not directly involved with the running of the home, is visiting and monitoring the satisfaction of residents and the services that are provided, in line with Regulation26. It was discovered that an allegation of misconduct had been made against the home and the doctor who visits. This was investigated and disproved however, the Commission was not informed at the time. Care must be taken to ensure that any allegations are reported in line with Regulation 37. The home does not take responsibility for the finances of any of the residents. They all have relatives or representatives who are able to help them with this. Staff supervision has now been started and staff that were spoken with agreed that they found this protected time beneficial and that they were able to discuss their performance and training needs in confidence. This will be developed in future with more trained nurses taking on the supervisor’s role. The Pre-inspection Questionnaire provided evidence that maintenance of equipment and services in the home is generally appropriate. Kitchen records were in also in order. It was noted that hot water temperatures are not monitored regularly and this must be done on a weekly basis and bacterial water analysis testing needs to be repeated. A requirement was given to address these issues. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 22 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 2 Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 23 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 4,5 Requirement The Service User Guide and Statement Of Purpose must be amended to include all of the requirements of The Regulations and produced in a format, which is suitable for the needs of the people for whom it is intended. The pre-admission assessment must contain evidence that the social needs and preferences of residents have been considered so that they can be sure that life in the home will suit them. Timescale for action 30/10/07 2 OP3 14(1) 30/10/07 3 4 OP8 OP9 15(2)(b) 13(2) 5 OP12 12(1) Care plans must contain 30/10/07 evidence that changing care needs are identified. All medication including external 30/10/07 preparations must be individually prescribed and not left out for communal use. The Responsible Person must 30/10/07 ensure that there is an activities programme in place, which will suit the capabilities of residents and provide them with interest and stimulation. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 24 (Previous timescale 30/03/07 not achieved.) 6 OP19 23(2)(b)( d) The planned programme of maintenance and redecoration of the home must be started. Storage facilities within the home must be improved. (Previous timescale 30/03/06, 30/08/06 30/03/07 not met) 8 9 10 OP33 OP38 OP38 26 37 13 (4)(c) There must be evidence of visits undertaken to monitor the home in line with regulation 26 All adverse incidents must be reported to the Commission in line with regulation 37 The temperature of the hot water must be monitored and recoded on a weekly basis to ensure that it remains around 43 degrees Celsius. There must be evidence that bacterial analysis testing of water has been undertaken to ensure the absence of Legionella. 30/10/07 30/10/07 30/10/07 30/10/07 7 OP22 13(4)(c) 30/10/07 11 OP38 13 (4)(c) 30/10/07 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 OP16 Good Practice Recommendations It is recommended that the complaints policy should be
DS0000026250.V346541.R01.S.doc Version 5.2 Page 25 Kimberley Nursing Home 2 OP29 produced in a format that is easier for the people who live in the home to understand. It is recommended that copies of job descriptions and contracts should be kept in staff files and available for inspection. Kimberley Nursing Home DS0000026250.V346541.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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
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