Inspection on 01/02/07 for Kineton Manor

This inspection was carried out on 1st February 2007.

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.

Other inspections for this house

Kineton Manor 31/10/08

Kineton Manor 18/02/08

Kineton Manor 13/03/06

Kineton Manor 09/08/05

Kineton Manor 15/12/04

Kineton Manor 11/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kineton Manor Manor Lane Kineton Warwickshire CV35 0JT Lead Inspector Jean Thomas Key Unannounced Inspection 1st February 2007 10:15 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 Kineton Manor DS0000004398.V325110.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. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kineton Manor Address Manor Lane Kineton Warwickshire CV35 0JT 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) 01926 641739 01926 642220 Mr Ken Inglefield Mr Edward Graham O`Rourke Dr Paula Philippa du Rand Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2006 Brief Description of the Service: Kineton Manor is a large converted manor house situated in the village of Kineton and is close to the village amenities. It is set in its own extensive grounds with an outlook onto open fields. The home is surrounded by well kept gardens and a large lawned area. The home is registered to provide personal and nursing care for 42 elderly service users. Ample car parking is available to the rear of the home. The service user accommodation is provided on two floors with 31 single ensuite rooms and 5 ensuite shared rooms. There are two lounges and one dining area. A lift is available to access all floors. The current proprietors Mr Inglefield and Mr O’Rourke have owned the home for over 18 years. The current scale of charges is in the range of £500.00 - £720.00 per week and includes, chiropody, hairdressing and toiletries. The fees do not include private newspapers or telephones. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was a key unannounced inspection visit and took place on Thursday February 1st 2007, commencing at 10.15am and concluding at 5:45pm. A key inspection addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. On the day of the inspection visit, there were 42 residents and it was the assessment of the manager that the majority of the residents had medium dependency needs. Since the last inspection two random inspection visits to the home have been made by a pharmacist inspector to look at the management of medication. The first visit took place on June 8, 2006 and identified a number of shortfalls. The second visit was to confirm compliance and took place on January 30th 2007. This inspection visit showed significant improvements in the management and administration of medication and the outcome is included in the ‘Health and Personal Care’ section of this inspection report. The inspector had the opportunity to meet most of the residents and talked to four of them about their experience of the home. Residents were able to express their opinion of the service they received to the inspector and conversation was held with other residents. During the visit, records and documents were examined and an opportunity was taken to tour the premises. Two visiting relatives, a friend of a resident, five staff members and the manager were spoken to and at the end of the inspection; feedback was given to the manager. 40 comment cards were sent to residents and their relatives. At the time of writing the report, 20 residents and 15 relatives had responded. An audit of residents’ comment cards shows satisfaction with the service provided. For example: residents receive the care and support they need and know who to speak to if they are unhappy. Staff members listen and act on what residents say and are available when residents’ need them. The home is always fresh and clean. An audit of relatives’ comment cards also shows satisfaction with the overall standard of care provided. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 6 Since the last inspection visit, there have been no complaints or allegations of abuse made to the commission or to the home. The registered manager was present during the inspection and cooperated fully with the inspection process. The inspector would like to thank residents, staff and visitors to the home for their cooperation and hospitality during the inspection visit. What the service does well: What has improved since the last inspection? The medicine management has improved to a high standard. Good systems have been installed to safeguard the health and wellbeing of the residents who live in the home. Information supplied to new residents included the methods and payment of fees. Daily records completed by nurses provide clearer information about how residents individual needs are being met and show that care provided is as agreed on the care plan. Cleaning products are stored safely and securely and a dedicated hand washbasin has been installed in the laundry room. 10 preset valves have been installed to high-risk areas to control hot water temperatures and risk assessments carried out where water temperatures may exceed the recommended 43°C. Further work is planned as part of an ongoing Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 7 programme to install preset valves in all areas of the home that may pose a risk to residents. Staff recruitment information is available in English so that appropriate recruitment checks can be carried out and any gaps in employment history explored. Staff training records are available and show that staff members attend a range of mandatory health and safety training. An obstruction in one corridor identified during the last inspection visit has been removed. A five-year electrical wiring check has been carried out and a certificate issued and electrical checks on portable appliances also completed. The fire risk assessment has been reviewed and updated and more exit signs displayed and a filing cabinet removed from next to one of the fire exit doors. 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. Kineton Manor DS0000004398.V325110.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 Kineton Manor DS0000004398.V325110.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): 3 Quality in this outcome area is good. Prospective residents have their needs assessed before moving into the home and staff have the necessary skills and ability to meet these needs. Standard 6 is not included in this judgement, as the home does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective residents have their initial care needs assessed and are encouraged to visit the home before deciding whether to move in for a trial period. The manager understands the procedures required to ensure that the home could meet the assessed needs of the prospective resident. The manager visits prospective residents to assess their care needs and to provide information about the home. A record of the initial care needs Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 10 assessment is held and used to determine whether the residents care needs can be met. A record of the most recent assessment was seen and although the assessment was not detailed and wide-ranging the manager said she felt there was sufficient information to enable her to make a decision as to whether the home was able to meet the individuals needs. Upon admission to the home a detailed care needs assessment is carried out. Three assessments were read and include information about the residents background; personal circumstances and care needs. The initial care needs assessment forms the basis of the residents care plan, and is recorded and agreed shortly after admission. Three of the four residents spoken with said they had been given the opportunity to visit the home before deciding whether to move in and one resident said they could not remember. In response to shortfalls identified during the last inspection, visit information supplied to residents now includes the method of payment and the fees charged. The home does not provide an intermediate care service. Kineton Manor DS0000004398.V325110.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): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have individual care plans that provide staff with the information they need to ensure care needs are met and have access to community health care services. Residents are treated with dignity and respect and their right to privacy upheld. The home has a high standard of medicine management and nursing staff were aware of and understood the need for good medicine management and a quality assurance system to confirm that practice reflects policy. EVIDENCE: The care plans of two residents identified for case tracking were selected for closer examination and show that care plans are based on the initial care needs assessment. Each care plan holds a range of information including; nutritional needs, personal care needs, health care needs and interventions. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 12 There is information about when staff support is needed but not much information about the residents physical and mental capacity to promote and maintain independence. For example, one care plan includes support of “one carer to assist to wash and dress” but fails to identify whether the resident can carry out any element of the task independently. This was discussed with the manager who said she plans to review care plans and to look at how greater independence may be promoted and maintained. An evaluation of the care plan for each identified need is documented each month and the care plan updated following any changes. Residents are registered with a local surgery and receive health-care support services as required including a dentist and optician. Three residents spoken to confirm they have regular access to Gp’s and other heath related care services including hospital outpatient appointments. Comments on residents’ comment cards include; the nurses take my blood pressure if Im not well, and the doctor comes regularly and the doctor is available when I need him. Also the nurses are available when I need them. A chiropodist visits the home every six weeks and the cost is met by the home. One resident had decided to continue to use their own chiropodist and this had been respected. Residents requiring specialist equipment such as a pressure relieving mattress, cushion or hospital type bed have their needs assessed by a nurse and any equipment assessed as necessary for promoting the health and welfare of residents is supplied by the home. Observations showed that a number of residents have adjustable height beds and pressure relieving mattresses. Nurses spoken with talked about the care provided and said none of the residents have pressure sores and one resident was being treated for a tissue wound (leg ulcer). Six residents have diabetes and there were no residents assessed as having ‘challenging behaviour’. In response to shortfalls identified during a previous inspection regarding poor health and safety, procedures for the management of oxygen the manager said a decision not to have oxygen in the home had been made. Risk assessments were carried out for range of activities that may pose a risk to residents and include moving and handling, prevention of falls and pressure sores, nutrition and for bed rails used to reduce the risk of residents falling out of bed. Case files read show that approval had been sought from relatives before bed rails were fitted. Two visitors spoken to said their relative has improved greatly since they have been here and was more mobile and had put on some weight. The pharmacist inspector visited the home to assess the standard of medicine management. This has improved to a high standard since the last pharmacist Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 13 inspection and all the previous requirements have been met. The managerial team and the nurses have worked hard to achieve this. The nursing staff had a good working relationship with the doctor and other healthcare professionals who visit the home. Two nursing staff were interviewed during the inspection and both had a reasonable understanding of the medicines they administer. Further training is encouraged by the lead nurse. The nurses check all the medicines received into the home and the local doctor has devised a new system to do this without the home seeing the prescriptions. This new system was to be implemented the following month. Random audits were undertaken to see if the medicines had been administered as prescribed. These indicated that the nursing staff administer the medication correctly and accurately record the transaction. The nurse in charge of medication undertakes regular audits twice a week to ensure that the medicines are safely given. All residents have individual “when required” medication policies detailing when a medicine can be administered when needed. All Controlled Drug balances were correct. Storage facilities were good for excess medication and the quantities of waste previously seen have reduced. Residents are given the opportunity to self administer their own medication if they want to but the majority of medicines are administered by the nursing staff. The doctor checks all new residents medication upon entry to the home. Residents who come to live in the home for short periods of respite care must have an adequate supply of medicines to last the period on entry to the home. Staff members were observed engaging with residents and were patient and encouraging. Residents were seen to receive personal care in private and staff knock on doors before entering resident’s rooms. 31 bedrooms are single occupancy and five double rooms each have screens to provide privacy for residents. Two residents spoken with said staff are “excellent” and “staff attitude first-class”. The home employs male and female carers. Information held on case files shows that residents are consulted about gender issues and their preferences sought regarding male or female carers to provide personal care. While resident’s views are recorded, their wishes are not always respected; for example, information held on one resident comment card includes I prefer not to have male carers, but this has not been listened to. On the day of inspection, residents looked well groomed and cared for. Staff members were aware of residents’ needs and were attentive towards them. Residents were observed to recognise and call staff by their names and were at ease asking for assistance indicating a good relationship between staff and residents. Three staff members talked about the arrangements for promoting and maintaining residents’ privacy and dignity, and said health care Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 14 consultations and treatments take place in the privacy of the resident’s own room. Residents spoken to confirm this occurred. All the residents spoken to during the inspection visit said the staff were kind and respectful but information held on one resident comment card included sometimes I find the carers appallingly rude. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 15 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): 12,13,14 and 15 Quality in this outcome area is good. Residents are able to choose their lifestyle, social activity and maintain contact with family and friends. Residents receive a healthy and varied diet according to their assessed needs and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a flexible visiting policy that takes into account the individual needs and expressed wishes of residents. Three visitors spoken to confirm visiting is flexible and said they are always made to feel welcome. Comments include, we can visit when we like and we are often offered a cup of tea,” Residents were observed to receive visitors in one of the communal lounges or in the privacy of their bedrooms. The home supports residents in their spiritual needs by the involvement of church ministers of varying denominations or assisting them to attend places of worship in the local community according to the expressed wishes of the resident. Representatives from the Anglican, Methodist and Catholic Church visit the home once a month and a religious service is held at the home each Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 16 week. One staff member spoken to said that five residents regularly go to church. On the day of the inspection visit, a number of residents were observed to be engaged an art and craft activity. Residents said how much they enjoyed the activities. One resident showed the inspector a card she was making and said she could not decide how she was going to decorate it. The person arranging the activity had brought their dog into the home and residents were clearly enjoying having the dog there. Since the last inspection, an activity organiser has been employed and residents have opportunity to participate in a range of social activities both in the home and in the local community, which met their needs. The activity programme was seen and includes; weekly exercises and arts and crafts, bingo and massage and manicure on request. The home has an extensive library that includes a number of books in large print supplied by the local library service. A number of residents spoken to were aware of when activities were taking place and said staff made sure they were able to attend if they choose. Trips out are encouraged and staff or relatives support residents who want to visit local shops. Some information about activities is displayed in the home. A hairdresser visits the home each week and the cost of the service is met by the home. Care plans selected for closer examination held details of residents past hobbies and interests but one resident was very frail and unable to pursue their hobbies or interests. Records held for one resident shows they like music and that an audiotape or radio was played for their enjoyment. Information held on resident’s comment cards includes; I enjoy the exercise and we have a jolly good laugh doing it I cant see or hear very well, but I like to join in I like to sit in my room and I take part in art class and exercise. One resident felt that the activity programme did not meet their particular needs I think the activities are childish and most of the people cant speak. I would like someone to come in and do a serious talk on an interesting subject. Residents spoken to said there were no restrictions and they could get up and retire when they liked. Preferred times for getting up and going to bed were included on the care plan and residents said they had regular baths and could generally have a bath when they chose. One resident comment card includes; they have this thing about cleanliness, you got to have so many baths a week Id rather be free. A tour of the premises found the kitchen was clean and well managed. Temperature records of the fridge and freezers were seen. The cook talked about the arrangements for cleaning the kitchen and showed the inspector a cleaning schedule. Store cupboards hold a range of provisions including fresh Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 17 fruit. Four weeks menus were examined and show a varied and nutritious diet that offers alternatives. The meals provided are good with specialist diets (including diabetic) and choice catered for. The cook said she makes cakes, puddings and pies regularly and upon request birthday cakes for residents. A number of homemade cakes were stored in the freezer and mince pies were on a cooling tray. Food stored in the fridge and freezers was dated so that the home could be sure food offered to residents was fresh. The inspector was shown a food hygiene inspection certificate with a silver rating awarded to the home by Stratford-upon-Avon management partnership working with Stratford and district Council for their efforts. Menus are held in the kitchen and the daily menu is displayed on the door leading into the kitchen. Each morning a staff member visits residents to tell them of alternatives and records their preferences. A number of residents have a cognitive impairment or other health related conditions and lack the ability to communicate. The inspector was shown photographs of meals that have been provided by the home and which are shown to residents so that they are able to continue to exercise their right to choice. Observations at a mealtime showed that residents were offered French onion soup, cottage pie or pork goulash with vegetables or a salad followed by ‘special sponge and custard’. Food was plentiful very well presented and nutritious. A number of residents had their meal in the dining room and some on a tray in their bedroom. Staff served meals at the dining tables so that residents could see what was on offer and could inform the staff of how much food they wanted on their plate. Residents who did not have their meal in dining room were given soup and the main course at the same time. The main course should not be served until residents have finished their soup as the meal may be cold by the time residents are ready to eat it and therefore less palatable. A number of residents whose nutritional needs were giving cause for concern were given high protein food supplements prescribed by their doctor and used to maintain nutrition. Although the staff were clearly very busy residents were unhurried making mealtime a pleasurable experience. Observations showed staff members were aware of the individual dietary and support needs of residents. The care plans of two residents being cared for in bed included the need for a soft diet. Observations showed that residents were given a soft diet and were supported in a manner that engaged and encouraged them to eat their food. Staff were observed to assist the residents to raise their upper body before having their food so that they were not placed at risk of choking. Breakfast was flexible according to individual needs and preferences. Records showed that residents were offered bacon, eggs (‘prepared in the style of the resident’s choice’), sausage, fried bread and tomatoes, cereals, toast, and Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 18 preserves. Supper includes a hot choice, assorted sandwiches, soup and choice of dessert. Residents enjoyed a choice of non-alcoholic drinks with their meal and hot drinks were offered to residents regularly throughout the day. Four residents talked about the meals and said they were very satisfied comments included; “the foods lovely” and “you can have what you want”. Information on residents’ comment cards included I like my breakfast especially porridge they could do with a little more salt in the vegetables” “I can’t eat half of them they just do not suit me. I would love to see chops and proper meat” and “If I don’t like the menu then I just have a sandwich. I would like to see a printed menu”. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 19 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): 16 and 18 Quality in this outcome area is good. The home has appropriate policies and procedures in place to safeguard residents from abuse. Complaints are listened to and are taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the home and included in the information given to residents before they move into the home. Records held in the home show that the last recorded complaint was November 19th 2004. We have not received any complaints about the service since the last inspection. Records show the manager responds to complaints in writing and may invite the complainant to attend a meeting to discuss the issues raised. Details of any investigation or outcomes were not held. Three residents spoken to said they would complain to the manager or to a nurse if they were unhappy about the service. Residents said they had not had cause to complain and felt any complaints would be taken seriously and dealt with appropriately. A ‘family and visitors comment book’ was held on each floor and although entries were not made regularly there was evidence of service satisfaction. An audit of comment cards received from residents shows that the majority of residents know how to make a complaint; comments noted include, matron I Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 20 suppose I would go through the channels and get my daughter to help me and tell someone who is in authority. One resident felt complaints were not taken seriously I dont feel it would be worthwhile to make a complaint. This is because I feel it wouldnt go anywhere. Comment cards show that six out of 15 relatives had complained about the service. There are discrepancies between what management and relatives see as a complaint. The manager said she did not record what she considers minor issues and has difficulty defining complaints and concerns. It is recommended that any service dissatisfaction brought to the attention of management and the outcome be recorded and included in the home’s quality assurance audit. The home’s policy for responding to allegations of abuse is available with clear guidance for staff to follow. Records show that staff have attended training for the Protection of Vulnerable Adults (PoVA) and that further training is planned to take place in June and August 2007. Four staff spoken with gave examples of what actions may constitute abuse and how possible abuse may be identified. Staff were aware of the ‘Whistle blowing’ procedure and said they would report any concerns to the manager or a nurse and were confident that any issues would be responded to sensitively and appropriately. Staff members said residents were well cared for and they have no concerns. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 21 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): 19,20,23,24,25 and 26 Quality in this outcome area is good. The design, layout and facilities provided, enables residents to live in a safe and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a relaxed, cosy and friendly atmosphere. The environment is clean, pleasant and generally well maintained. Residents spoken to were very satisfied with their accommodation and could bring small items of furniture and personal possessions into the home with them. For example, one resident has a small oak sideboard and another there own armchair. Other personal possessions seen include plants, photographs, ornaments and small tables. Four residents invited the inspector into their rooms and the inspector visited the rooms of a further three residents who were being cared for in bed. All but one of the rooms seen was personalised Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 22 and reflected the resident’s lifestyle. Residents spoken to were very satisfied with their accommodation. A double room occupied by two residents and who were being cared for in bed was not personalised and was sparse. The room did however provide staff with the space needed for safe use of any moving and handling equipment necessary to meet the needs of the residents. Communal areas of the home are spacious, comfortable, light and airy. Armchairs are comfortable and clean. Carpets and the decoration are generally in good condition. The inspector was shown a new table and chairs that had been recently purchased and for use in the conservatory extension. Comments from residents spoken to include Im very fortunate I have everything I need and the cleaners they’re very very good, very kind. They collect the rubbish regularly. Comments noted on resident’s comment cards include I love it here and have never had such a lovely view” I would like more chairs in my room for visitors and its a beautiful place. Residents have access to a call alarm system and can move around freely and there were generally no hazards to their safety when mobilising. A tour of the premises showed that a toilet on the first floor was used for storage purposes. This was discussed with the manager who said residents did not use the toilet as they have a toilet in their room. The manager was aware entry into the toilet may pose a risk to residents and said she plans to look at either removing the items or making sure the door is secure so that residents are not at risk. The laundry is equipped with two washing machines and two dryers. Staff talked about the arrangements for managing the laundry, which includes making sure soiled and clean items, were held separately. Linen containers are available on each floor and identify which items are to be placed in each container so that staff do not mix items that need to be laundered differently such as woollens and bed linen. Soiled linen was held and washed separately at appropriate hot water temperatures and necessary to make sure linen is clean and reduce risk of infection. Two residents spoken with said they were satisfied with the laundry service and found that personal items were generally returned promptly. One resident said some of their clothing had not been returned. Observations during the inspection showed residents were nicely presented and their clothes were clean and not creased. Systems are in place to reduce the risk of infection. Disposable gloves, aprons and hand scrub are available and used by staff when handling soiled linen and when supporting residents with personal care. Staff were observed wearing disposable plastic aprons when serving food but did not always wear protective clothing when entering food preparation areas in the kitchen and necessary to minimise the risk of infection and cross contamination. The prevention and control of infection was discussed with the manager who said staff had been instructed to wear protective clothing when entering the kitchen and she Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 23 planned to raise this issue with the staff to make sure they always follow the home’s policies and procedures. In response to concerns identified during previous inspection visits about the risk of scalding from hot water temperatures, the manager said 10 preset valves had been installed to high-risk areas to control water temperatures and risk assessments carried out where water temperatures may exceed the recommended 43°C. The manager said further work is planned as part of an ongoing programme to install preset valves to all areas of the home that may pose a risk to residents. The manager said that water temperature checks had also been carried out on September 15 2006 to make sure water is stored at a temperature of at least 60°C and distributed at 50°C minimum to prevent risks from Legionella. Ramps provided safe and easy access to the gardens, which were attractive, spacious and well managed. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 24 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): 27,28,29 and 30 Quality in this outcome area is adequate. Sufficient numbers of experienced and qualified staff are available to provide care for residents but shortfalls in staff recruitment practices may place residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection visit, there were 42 residents and a staff complement of registered manager, two administrators, three Registered General Nurses (RGN), 10 care staff and an ancillary worker. Three domestic staff and a supervisor carried out housekeeping and laundry tasks. A cook and kitchen assistant prepared the meals and any repairs or other related tasks were carried out by maintenance workers and gardeners. The manager informed the inspector that the usual staffing complement for the home is: 07:30 – 4pm 08:00-5pm 3.15pm – 9:30pm Kineton Manor 2 Registered Nurses and 10 care staff 1 Registered Nurse 1 Registered Nurses and 6 care staff DS0000004398.V325110.R01.S.doc Version 5.2 Page 25 9pm – 8am 1 Registered Nurse and 3 care staff In addition, there were sufficient laundry, catering, cleaning and maintenance staff to ensure that nursing and care staff did not spend time undertaking noncaring tasks. The registered manager is also a general nurse but was not included in the number of nurses on duty. Four weeks of duty rotas for nursing and care staff was examined. The rota was generally sufficiently maintained to give detailed information of the numbers, names and qualifications of staff on duty. It was difficult for the inspector to establish from the rota supplied the designation of some of the staff on duty. For example, the names of administrative staff were included with the nursing staff but their role not defined. The manager should revise the rota and clearly identify the administrative and any other support staff working at the home. In response to requirements made during the last inspection visit the duty rota shows there are sufficient numbers of staff available in the mornings to meet the needs of residents. Information supplied by the home shows that since the last inspection 12 staff have left the home. The manager talked about the impact of having other care homes in the area, which meant it, was often difficult to employ suitable staff. In response to staff, shortages a number of overseas staff had been employed through an agency. Staff spoken to confirmed this and said the home had been short staffed last year and a number of new workers had been employed and staffing was now “much better”. Staff members said there were sufficient numbers of staff available to meet the needs of residents. Residents spoken to made positive comments about the staff saying, “they are excellent” and “they look after me very well”. 16 of the 20 residents’ comment cards expressed the view that staff listen and act on what they say. Additional comments included; they take care of me and if there is anything I want they do it sometimes the foreign nurses dont understand what I say. It is a language barrier more than anything. I dont think they understand my condition”. Resident comment cards also show that staff are generally available when they need them. Comments noted include; they are always available if I need any help have never had any trouble with them I dont think there are enough staff. Occasionally I have to wait for the commode in the morning, Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 26 because I need a hoist and it is usually in use and on the weekends there is not a soul about. Comments received from relatives include; “staff are very good” and there always enough staff about”. 12 out of the 15 comment cards received from relatives expressed this opinion. Comments on one relative’s comment card include: Kineton Manor has a loyal band of long serving dedicated to staff. However short term absence of short service carers is perceived to be a problem. On the day of the inspection visit, it was evident that the numbers of staff on duty were sufficient to meet the physical needs of residents. Staff interacted with residents and there was evidence of staff spending time with them to address any social needs. Information supplied by the home and before the inspection visit show that since the last inspection the number of qualified care staff has increased and 16 of the 26 care staff have now completed a National Vocational Qualification (NVQ) Level 2 in care or equivalent and exceeds the National Minimum Standard for 50 of staff to be qualified. Records show that a further six staff members commenced working towards the Award in January 2007. A number of staff have undertaken dementia care training and further training is due to take place in March 2007. Three staff members spoken to said training was very good and they were encouraged to attend any courses. Staff were enthusiastic about training and keen to explore any opportunities open to them. One staff member said they had been trained to carryout continence assessments and to make sure residents received products or equipment assessed as necessary for promoting continence and comfort. Examination of staff records confirmed the worker had attended appropriate training. The personnel files of three recently recruited staff were examined and show that satisfactory pre-employment checks such as Criminal Record Bureau (CRB) disclosures and checks made against the Protection of Vulnerable Adult (PoVA) register were not always obtained before staff started working at the home. For instance, one worker started work at the home on November 9th 2006 and before the outcome of the PoVA, check was known on November 15th 2006. References were secured from overseas and show that two workers were supplied with a copy of the same reference and only one of the three workers had completed an application form therefore the manager had not secured all the information necessary to determine the worker’s fitness. The manager said she had been unaware of this and said the presence of the new workers in the home would not have posed a risk to residents as they would have been on induction training and would have been supervised. Records held fail to show how the workers spent this time. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 27 The absence of a completed application form means that the manager would not be able to identify whether there were any gaps in employment history therefore the requirement made during the last inspection that management explore any gaps in employment history will be carried forward and looked at again during the next inspection. Examination of documentation shows that staff recruitment information is now available in English and shortfalls identified during the last inspection addressed. The home has a formal induction programme to ensure that staff are equipped with basic care skills. The induction programme requires staff to complete a number of learning modules and attend a number of training videos. The learning modules begin with ‘understanding the principles of care’ and when complete each module is signed off by the manager. Two workbooks were read including one belonging to a new worker. A certificate confirming completion was also seen. Records show that staff attend a range of mandatory health and safety training and updates. (Further information is included in the Management and Administration section of this report) Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 28 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): 31,32,33,35,36 and 38 Quality in this outcome area is good. The home has an effective management structure to provide direction and guidance to ensure residents receive consistent quality care. Quality assurance monitoring is implemented as a core management tool and used to enhance service delivery. The management of health and safety generally protects residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is an experienced qualified nurse with a PhD in nursing and has been in post as a manager at Kineton Manor since November 2003. She is had completed the Registered Manager Award (RMA) and participates in periodic training to update her knowledge, skills and competence. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 29 There were clear lines of responsibility and accountability within the home and as well as the manager the senior team includes three senior nurses, nine nurses and four senior carers. Each senior team member has key areas of responsibility and as such is accountable to the manager. The management approach of the home creates an open, positive and inclusive atmosphere and the registered manager communicated a clear sense of direction and leadership. Four residents spoken to knew who the manager was and said she was always available and easy to talk to. Residents said the home was well managed and their relatives and visitors were always made to feel welcome. Three staff spoken to said residents were well cared for and the manager and senior staff were always available to offer any support or guidance as needed. Staff records read show that regular formal one to one staff supervision and appraisal is carried out and used as part of the normal management process to monitor staff practices to ensure residents’ health, safety and welfare is maintained. The home conduct quality surveys twice a year involving residents and once a year involving family members. Service objectives agreed by management are reviewed once a year. The manager talked about the quality review process and said the next quality survey is due to take place in March 2007 and the consultation exercise is to be extended to include other stake holders such as Gps, social workers and other health and social care professionals. An audit of surveys was carried out and the outcome used to inform the home’s annual objectives. The outcome of inspection visits undertaken by the commission is also used as an additional tool to measure the quality of the service and any shortfalls identified are included in the home’s annual action plan. Regular visits by the registered person or their representative to monitor the service are being implemented as required by the Care Home Regulations 2001 and necessary for ensuring that the service is being regularly monitored and the health, safety and welfare of residents protected. The management was unsure of how many residents independently managed their finances. Some residents’ finances were managed with informal assistance from relatives or through Power of Attorney arrangements. Two residents spoken with said family members supported them. Information supplied by the home shows that the manager does not act as appointee for any residents for their benefits or manage any savings. Neither does the home act as agent to collect benefits on behalf of residents. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 30 A number of residents or their relatives deposit money at the home to be used for services or items purchased on residents’ behalf. Monies and records of financial transactions are held in individual and named plastic envelopes. Money belonging to two residents was checked and showed accurate recording. Relatives or residents depositing money for safekeeping are not issued with a receipt confirming the transaction. Instead, two staff signatures are obtained to confirm money has been received. Receipts should be issued for money received from or on behalf of residents and should include items held for safekeeping. The administrator responsible for managing the service said she understood why this was necessary and plans to introduce new procedures that will further safeguard residents. Records of any accidents or incidents were held and were reported to the commission in accordance with the Care Homes Regulations 2001. A tour of the premises identified that a door leading into the kitchen had been wedged open. Staff advised the inspector that this was only done at mealtimes as a means of providing staff with safe and easy access to the kitchen when there were high levels of staff activity. Observations during the rest of the inspection visit showed that the door wedge had been removed. The issue of preventing doors from closing in the event of fire was identified during the last inspection and management were required to make sure the doors identified were not wedged open. The manager must make sure staff are aware of the risks and must actively promote and ensure safe working practices. The manager said she would seek advice from the fire officer to determine whether an automatic door closure that links to the fire alarm system could be fitted. Documentation shows that all registered nurses and two other workers were trained in first aid so that a first aider was always on duty. We obtain information before inspections that includes confirmation that all necessary policies and procedures are in place and are up-to-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents and staff safe. In response to requirements made during the last inspection visit records show that Portable Electrical Appliance Testing (PAT) was carried out in January 2007 and a review of the fire risk assessment carried out and updated. More fire exit signs are displayed and a filing cabinet located next to a fire door was relocated. A new electrical wiring certificate was issued on 01/11/06, and the assisted baths, hoists and wheelchairs were serviced in 2006. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 31 The fire alarms were tested weekly and the most recent fire training took place on 19/06/06. Two staff spoken with said they attended fire drills and have been trained in health and safety procedures. Information supplied before the visit to the home shows that further training and updates are due to take place and include, manual handling in January and April 2007 and Fire procedures February, June and September 2007. Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 32 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 3 3 3 X X 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 33 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 OP29 Regulation 19, Schedule 2 Requirement The registered person must review staff recruitment procedures in the home to ensure a robust and consistent approach to staff recruitment and employment practices. Gaps in employment history must be explored with the applicant and explanations recorded as appropriate. (Not assessed during this inspection visit and the timescale for compliance is 31/05/06) The registered person must not employ staff to work in the care home without first securing the outcome of checks made against the Protection of Vulnerable Adult (PoVA) register or Criminal Record Bureau disclosure. (CRB). The registered person must 02/02/07 ensure that doors are not held open with devices, which prevent them closing in the event of a fire. (Outstanding from June 06) DS0000004398.V325110.R01.S.doc Version 5.2 Page 34 Timescale for action 01/02/07 2. OP38 13,23 Kineton Manor The registered person must ensure staff wear protective clothing when entering food preparation areas. 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 OP10 Good Practice Recommendations Care plans should be further developed to include information about the residents physical and mental capacity to promote and maintain independence. Residents expressed wishes regarding the provision of personal care from someone of the opposite gender should be acknowledged and their wishes respected and make sure all staff treat residents respectfully. Consult with residents about planning activities so that the home can be sure all residents’ needs are being met. Consult with residents to make sure they only have a bath when they want one and that bathing is not being imposed on any of the residents. Make sure residents are not given their soup and main meal at the same time so that the food does not go cold and their meal spoilt. It is strongly recommended that residents have access to daily menus and menu planning should be revised and include a wider range of meat dishes and includes chops. It is recommended that details of complaints investigations and outcomes are held and used to further develop the service. Records should be held of what may be considered as ‘minor issues’ brought to the attention of management so that service provision and outcomes are being properly monitored. Items requiring storage should not be left in a toilet that is accessible and which may be used by residents. Residents or family members depositing money or personal possessions for safekeeping should be issued with a receipt. 3. 4. 5. OP12 OP14 OP15 6. OP16 7. 8. OP19 OP35 Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 © 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 Kineton Manor DS0000004398.V325110.R01.S.doc Version 5.2 Page 36 - 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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