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Inspection on 27/02/06 for Kimberly House Nursing Home

Also see our care home review for Kimberly House Nursing Home for more information

This inspection was carried out on 27th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

An admission to the home took place during the inspection. It was observed how well the staff introduced themselves and was supportive to the new service user and family representative providing reassurance to both parties. Kimberly provides a homely environment, which is well maintained. The standard of hygiene in the home was good. Service users were complimentary of the food provided. A recently admitted service user reported the care as good and felt settled into the home.

What has improved since the last inspection?

All medication was fully labelled with the appropriate service users` name on all containers and an up to date medications reference manual was in place. The staff had received training in the local vulnerable adults procedures. All call bell leads were long enough for service users to be able to use once out of bed. Carpeting through out the home was clean. The documentation relating to wound care was detailed and up to date. The Manager has put much work into reviewing the care plans, which were up to date.

What the care home could do better:

All service users should be provided with a call bell at all times. The Manager should review the pressure relieving equipment available for use in the armchairs to ensure the equipment meets the needs of the service users who are very frail but could spend more time out of bed. Service users should be encouraged to use the dining room and communal areas as only one person was seen using the communal room to increase social interaction between service users. When a food supplement is prescribed by GP the service user must receive the food supplement. Nutritional risk assessment should be implemented. The wheelchairs should not be stored in the communal toilet.

CARE HOMES FOR OLDER PEOPLE Kimberly House Nursing Home 1 Fowlers Hill Salisbury Wiltshire SP1 2JF Lead Inspector Karen Mandle Unannounced Inspection 27th February 2006 9:30 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 Kimberly House Nursing Home DS0000050617.V278670.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. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kimberly House Nursing Home Address 1 Fowlers Hill Salisbury Wiltshire SP1 2JF 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) 01722 322494 Wessex Care Ltd Manager post vacant Care Home 21 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (21), Terminally ill (1), of places Terminally ill over 65 years of age (1) Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The staffing levels set out in the Notice of Decision issued by Wiltshire Health Authority on 2 July 2001 must be met at all times No more than one person age 50 years or older may be accommodated for nursing care within the designated crises bed. No more than 1 service user between the ages of 55 and 65 years with Dementia may be accommodated at any one time 22nd July 2005 Date of last inspection Brief Description of the Service: Kimberly House is registered to provide nursing care for 21 older people aged 65 years and older. Kimberly House is an older building, which is well maintained and offers a very homely living environment for Service Users. The home is situated about half a mile from the city centre of Salisbury in Wiltshire.The home is owned by Wessex Care Limited, the owners of the company Mr and Mrs Airey remain very much involved in the day-to-day running of the home. The Acting Manager is Mrs June Coyle RGN Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Kimberly House commenced at 9.30am and was completed at 1.45pm. The Acting Manager Mrs June Coyle RGN assisted the inspector. The home was caring for 18 service users requiring nursing care. The inspector was able to freely tour the home and visit with many of the service users, however communication with some service users was limited. The home was calm and organised. The care records were reviewed as was the medication records. What the service does well: What has improved since the last inspection? All medication was fully labelled with the appropriate service users’ name on all containers and an up to date medications reference manual was in place. The staff had received training in the local vulnerable adults procedures. All call bell leads were long enough for service users to be able to use once out of bed. Carpeting through out the home was clean. The documentation relating to wound care was detailed and up to date. The Manager has put much work into reviewing the care plans, which were up to date. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 6 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. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 the following standard(s): 3 A clear admission procedure is in place and all needs are assessed during the pre admission assessment. EVIDENCE: All service users are assessed by Sally Ballinger Nurse Consultant for Wessex Care prior to admission to Kimberly House. A pre admission assessment was reviewed for a service user who was being admitted to Kimberly during the inspection for long term nursing care. The assessment was inclusive of shortterm nursing care needs and long term care needs. A record of the assessment is kept on the service users’ file. The admission procedure of the service user was observed. The care staff introduced themselves in a warm and friendly manner to both the service user and family member explaining different aspects of the home and provided an opportunity for the service user and family member to ask any questions. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 11 Health care needs are monitored and appropriate action taken when health care needs change. The care plans address all aspects of care apart from nutritional risk assessments. The medication procedure is safe. EVIDENCE: All service users are provided with a care plan. The inspector reviewed 4 care plans. It was evident that the Acting Manager Mrs Coyle had been working through the care plans to up date and review many aspects of the care records. A service user who had only been admitted the previous week had a care plan in place, which was quite detailed and was still being implemented as the nursing staff gained further knowledge of the service users’ care needs. Nutritional risk assessments should be introduced for service users with low or high weights ensuring that all dietary needs are being met. When a service user is ordered a food supplement this should be given. A wound chart was seen which was detailed and provided up to date information of the wound and the healing process. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 10 All service users are registered with a local GP. Written evidence of the GP visits were seen. Fluid and care charts were in place for those service users requiring more assistance. The charts were kept up to date through out the inspection providing evidence of service user being provided with regular fluids and care where needed. Communication with the service users was limited, however two service users confirmed with the inspector that they were happy with the care and support provided. Pressure relieving equipment was in place for those service users at risk of pressure damage. However four service users did spend the majority of their time in bed due to the risk of pressure damage whilst being out of bed. It is recommended that the home reviews the pressure relieving cushions used in the chairs with an aim to provide a cushion that allows service users to spend more time out of bed without increasing the risk of pressure break down. A very frail service user was observed during the course of the inspection that appeared very comfortable and well cared for. Three service users did not have their call bell available to them. The medication procedure was reviewed. Medication was stored correctly. The amount of stock medication was appropriate and again safely stored. The amount of controlled drugs was limited and recorded correctly. Hand written medication orders had not been signed by two members of staff ensuring the accuracy of the medication order. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 the following standard(s): 12 and 15 The activities provided support the social needs of the service users. Service users enjoyed the food and a varied well balanced diet is provided by the home. EVIDENCE: The Welfare Co-ordinator and Welfare assistant were seen visiting on a one-toone basis with service users and introducing themselves to the new service user. These roles are currently being developed and provide the activities between the three homes own be Wessex care, which are in close proximity of each other. Both employees spoke with the inspector who were very keen to provide stimulating activities to the service users of Kimberly House. The main hot meal of the day was provided at lunchtime. The meal was well presented and service users who were able to communicate were complimentary of the food provided. A homely dining room is provided on the ground floor, however all service users apart from one ate their lunch in their bedrooms. Service users requiring assistance with their meals were seen being helped on a one-to-one basis by the care staff. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 the following standard(s): A complaints policy and procedure is in place. Staff are now informed of the local vulnerable adults procedure and had received training in abuse awareness. EVIDENCE: A complaints policy and procedure is in place, which is available in the entrance hall of the home for service users and families to obtain. Wessex Care Ltd have a full complaints investigation procedure in place. Through discussion with Mrs Coyle about the complaints procedure it was evident that Mrs Coyle had an open and positive attitude to complaints. A procedure is in place for dealing with any allegation of abuse supported by a Whistle Blowing policy. The staff have now received training in “Abuse awareness”. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 the following standard(s): 19,24 and 26 Kimberly provides a clean and homely environment for service users to live in. The home is well maintained and clean to a good standard. The bedrooms are homely and personalised. Infection control is managed appropriately. EVIDENCE: Kimberly House is an older building, which is well maintained and very homely. On the ground floor there is a homely communal lounge area and a separate dining room both of which are well furnished. All of the bedrooms were visited. The bedrooms were personalised and homely depending on the service user and what personal belongings they had brought into the home with them. The majority of the bedrooms are single and vary in shape and size. Service users were happy with the accommodation provided. Where en-suites are not provided a sink is provided. The paint work in room 1, directly round the sink will need painting due to the risk of cross infection, with Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 14 this room being generally used for the crisis bed therefore with a much higher turn over of service users using the room. A communal toilet was being used for wheelchair storage on the second floor therefore the toilet was not assessable to service users or visitors. Infection control issues were managed appropriately and the home was clean to a good standard throughout with no unpleasant odours noted. The laundry facility was seen which was clean and organised. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 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 The staffing provided met with the staffing level required by the Commission. EVIDENCE: Kimberly is required to work to a staffing level as a condition of registration with the Commission. The home was working to this level of staffing. As part of the staffing level a trained nurse is on duty at all times supported by a team of 4 carers, which reduced during the evening and at night. The rotas seen provided evidence of these levels being maintained. The recruitment procedures and employment files are kept at the Wessex Care office situated in Little Manor Nursing Home therefore standard 29 was not assessed. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 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 and 38 The home is well maintained and health and safety issues addressed. The Acting Manager Mrs Coyle is not yet registered as the Manager for Kimberly House with the CSCI. EVIDENCE: Mrs June Coyle RGN is currently Acting Manager. Mrs Coyle’s application to become the Registered Manager of Kimberly has now been received by the CSCI. The home was calm and well organised under Mrs Coyle’s’ leadership. The fire log indicated that weekly testing of fire system was taking place, with monthly testing of the emergency lighting-taking place. Accidents are recorded and audited monthly by the Manager. Lifting hoists were regularly serviced, as is the passenger lift. The home is well maintained. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 18 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. 2. Standard OP8 OP8 Regulation 12 12(1,a) Requirement Timescale for action 25/03/06 3. OP9 13(2) 4. OP19 13(3) The Manager will ensure all service users are provided with a call bell. The Manager will ensure that 01/04/06 when a food supplement has been prescribed by the GP for an individual service user that service user receives the food supplement and that this is recorded on the medication record. The Manager will ensure all 25/03/06 handwritten medication orders transcribed on the medication administration sheets are counter signed by two members of staff one of which is a qualified nurse. The Manager will ensure the area 01/04/06 surrounding the sink in Room 1 is maintained in a condition that can be fully cleaned. Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 19 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. Refer to Standard OP7 OP8 Good Practice Recommendations The Manager should implement nutritional risk assessments as part of the care plan. The Manager should review the pressure relieving equipment used for chairs ensuring the equipment provided can meet the care needs of frail service users with the aim of those service user being able to spend more time out of bed. The Manager should encourage service users to use the communal rooms to provide increased social interaction between service users. The Manager should find alternative storage space for wheelchairs and not use the communal toilet for storage of equipment. 3. 4. OP8 OP19 Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kimberly House Nursing Home DS0000050617.V278670.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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