CARE HOMES FOR OLDER PEOPLE
Kingfisher Court Care Home The Spinney Sturgeon Avenue Clifton Nottingham NG11 8HE Lead Inspector
Dee Shelvey Unannounced Inspection 2nd February 2006 10:00 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 Kingfisher Court Care Home DS0000002206.V279023.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. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kingfisher Court Care Home Address The Spinney Sturgeon Avenue Clifton Nottingham NG11 8HE 0115 940 5031 0115 984 7071 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) Tawnylodge Limited Joan Pomeroy Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A service to be provided for one named service user with visual impairment and dementia. Application variation number V8877originally dated 24/05/04 1st August 2005 Date of last inspection Brief Description of the Service: Kingfisher Court is a purpose built home offering care and accommodation for up to 40 older people. In agreement with the Commission for Social Care Inspection the home has accommodated one person with dementia. The accommodation is sited over two floors with a passenger lift providing independent access for service users. Kingfisher Court shares a site with its sister home, the Spinney; situated on the edge of Clifton housing estate providing easy access to a range of local facilities including public transport links. There is a nature reserve to the rear of the property giving a pleasant outlook and a good sized car park to the side and rear of the property. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over five and three quarter hours. It consisted of reading documents, examining records, discussions with the manager and a limited tour of the building. The inspector had lunch with eight service users and was able to gather their opinions on the home. The inspection focused on checking set requirements and assessing standards not covered at the last inspection. What the service does well: What has improved since the last inspection?
Service users are no longer admitted until a full assessment of needs has been carried out and they can be sure that the home can meet their needs. The resulting care plans were more detailed so that staff know how to meet
Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 6 identified needs. Health service professionals were contacted when necessary and relevant instructions were included in the care plan. The acting manager had stressed the importance of treating residents with respect and preserving their dignity when working with them. On the day of inspection staff were observed to treat people with respect. The arrangements for protecting residents from harm and abuse had been improved and a copy of the Nottinghamshire Protection of Vulnerable Adults procedure had been obtained and made available to the staff group. All careplans contained a body map and staff had been instructed to complete these if any unexplained bruising was seen. What they could do better:
The only complaint received from the service users spoken with was about the food. It was said that although there was always enough it was boring and there wasn’t sufficient choice. On the day of inspection the meal choice was savoury mince with potatoes and mixed vegetables or vegetable bake. On the mince one person commented that the only ingredient apart from mince was tomato. The inspector had vegetable bake that consisted of a flat potato cake that also contained unidentified green vegetables. It was bland to the taste. The rice pudding also caused unfavourable comment; it was extremely sweet and had an unpleasant after taste. The acting manager said it had been made from “a packet”. The choices at teatimes often consisted of a variety of cold meats, which could be made into sandwiches or eaten with a salad. Service users spoken with said they had not been consulted about the menu. The acting manager said it was difficult to suit all tastes because the central kitchen provided the meals and catered for in excess of 90 places. New menus were about to be implemented and examination of these that the choices for tea were still very limited. Some had been employed to organise activities for the service users but records showed that the only pastime being offered was throwing a ball. The acting manager gave assurances that there was a wider variety on offer and commented that the record was not accurate or up to date. It is essential to
Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 7 consult with residents about activities, to record the results and devise an interesting programme based upon them. 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. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,and 5. Service users would not be admitted to the home without an assessment of needs. They are given satisfactory information and are encouraged to visit the home. EVIDENCE: The statement of purpose and service user guide had been completely rewritten and between them contained all the necessary information. Some information was included in the wrong document but the revisions would be simple to make. The acting manager said it would be done immediately. The case files of the last three persons admitted were examined and contained a full needs assessment. The acting manager was in the process of auditing all care-plans to make sure that they identify how needs are to be met. It would be of benefit to the home and service users if senior staff responsible for writing care-plans received appropriate training. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 10 The home encourages people to visit prior to making a decision to move in and would consider allowing a short stay if requested. A member of staff always visits a prospective service user either at their home or the hospital. If an emergency admission is accepted a social worker usually faxes an assessment to the home approximately 3 or 4 hours before arrival. The home also then insists upon an early review of the situation usually within 2 weeks. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Service users health needs are identified and met. Residents are treated with respect and are protected by the homes policies and procedures for handling medication. EVIDENCE: The 3 care-plans seen contained risk assessments where indicated and when the risk was determined as high an action plan to minimise it had been drawn up. Care-plans did not carry any evidence of the service user and/or their family being involved in the process. It is essential to do so in order that care can be provided as the resident wishes. Health care was monitored and there was evidence of referrals for appropriate specialist care. In one instance a dietician had been consulted and dietary supplements given in line with her advice. The residents weight was monitored regularly to inform future practice. The medications policy was satisfactory as were the storage and administration records. A pharmacist had recently inspected the procedures and no recommendations had been made.
Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 12 Service users spoken with confirmed that their right to privacy is upheld and they are treated with respect. Observations made during the day were evidence of a good relationship between the staff and service users. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15. Service users are satisfied with their lifestyle and maintain contact with their families. The meals served are bland and there is insufficient choice at teatime. People in wheelchairs need tables adapted to their use. EVIDENCE: Those service users spoken with were satisfied with their lifestyles and said the staff chatted with them. Some were happy to read or watch the television and occasional entertainment is provided. They said they had not been consulted about hobbies or activities and the activities record showed only throwing the ball had been offered. A visitor spoken with said families were always made welcome and observations during the day would confirm this. The dining room was pleasant with sufficient room for people to eat in comfort. Two people using wheelchairs however looked, and confirmed they felt, uncomfortable. The table was not high enough to get the arms of the chairs underneath; as a result the residents were not close enough to the table to eat in comfort. The meal on the day of inspection was uninspiring and one resident had to ask for it to be reheated. This issue has been covered in more depth in the inspection summary under “What they could do better”.
Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 14 Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users could be confident that complaints were taken seriously if the complaints procedure was followed. Service users are protected from abuse. EVIDENCE: The home had a satisfactory complaints procedure but this was not being adhered to. One service user spoken with had made a serious complaint and this had been discussed with the member of her family that assists her with finances. The issue had been resolved because it was found that the service user had made a mistake. The inspector spoke with the family member and he confirmed that the acting manager had contacted him quickly to sort out the problem. There was however no full record of receiving, investigating and resolving the complaint and the service user was not satisfied. The lack of formal response to the complainant suggests that the manager needs more training in this subject. It is essential if residents are to feel that their concerns are being properly addressed. A formal response could be referred to if the resident forgot the outcome and help to settle her mind. The arrangements for protecting residents from harm and abuse had been improved and a copy of the Nottinghamshire Protection of Vulnerable Adults procedure had been obtained and made available to the staff group. All careplans contained a body map and staff had been instructed to complete these if any unexplained bruising was seen. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 16 Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 17 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, 22 and 26. The home is well maintained, clean and hygienic. With the exception of the problems for wheelchair users in the dining room there are sufficient aids and adaptations to meet need. EVIDENCE: During the limited tour of the building it was evident that the home was satisfactorily decorated and furnished. The maintenance jobs pointed out during the last inspection had been attended to and no potential safety hazards were seen. The smoking room was adjacent to the large dining room and smoke was drifting between the two. The manager stated that a new extractor fan was on order and would shortly be fitted. A problem occurred in the dining room as covered in standard 15 above. The control of infection policy was satisfactory and the laundry area was clean and tidy with impervious floors. In rooms occupied by people with MRSA there
Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 18 were separate laundry bags and for staff aprons, gloves and bacterial handwash. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 19 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): 29 and 30. If followed the recruitment policy would offer protection to the service users. Staff receive training in the basic skills. EVIDENCE: The personnel files of the two latest employees were examined. They both contained all the documents proving identity as required by the care homes regulations. One person had not fully completed the application form and the home had no employment record. In addition open references had been accepted without proof of authenticity. Satisfactory CRB checks had been obtained. Staff receive training in food hygiene, first aid, fire safety etc. but there was no evidence of training specific to the client group. At least one service user had dementia; some were hard of hearing or had sight impairment. Some training on these areas and on the aging process would benefit the staff and residents. In addition the staff team, including the manager, could improve their recording and care-plan devising skills if training were provided. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 and 38. The acting manager needs to complete the registered managers award and receive immediate training on record keeping and care-planning. The home is run in the best interests of service users and their financial interests are safeguarded. If strictly followed the homes policies and procedures protect the residents rights promotes their health and safety. EVIDENCE: The acting manager demonstrated an understanding of the elderly and had already brought about improvements to the service but her managerial inexperience showed in some areas of record keeping. This was particularly evident when not formally responding to a complaint and accepting open references without proof of authenticity. She needs to make herself more
Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 21 aware of the national minimum standards and ensure that service users and/or families are consulted about all aspects of the service. The homes policies and procedures had all been audited but no action plan had been drawn up. Annual surveys are sent to relatives but only 2 returns were available for inspection. It is essential to gain the service users opinions on the service and independent advocates could assist in this exercise. The quality assurance scheme would benefit from gaining the opinions of visiting professionals. The results of all surveys need to be analysed to inform future practice. The fire safety records were examined and showed that safety equipment is tested at appropriate intervals. Water temperatures are taken as required and any potentially hazardous substances are held in locked storage. Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 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 3 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 3 Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 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 OP7 Regulation 15 Requirement There must be evidence that residents/their representatives are involved in the development and review of their care plan unless there are valid, recorded reasons for this not to occur. This is outstanding from 30/09/05 Residents hobbies and interests must be assessed, recorded and provided for. This is outstanding from 30/09/05 Service users must be consulted and their views taken into account prior to drawing up the menus. The menu for teas must offer real choice avoiding items that can only be made into sandwiches. Complainants must be formally responded to following the investigation. This is outstanding from 30/09/05 The dining room table used by people in wheelchairs must be adapted to allow them to get
DS0000002206.V279023.R01.S.doc Timescale for action 01/03/06 2 OP12 16 31/03/06 3 OP15 16(2)(i) 31/03/06 4 OP15 16(2)(i) 31/03/06 5 OP16 22 01/03/06 6 OP22 16, 23(2) 15/03/06 Kingfisher Court Care Home Version 5.1 Page 24 7 OP29 19(4) 8 9 OP29 OP30 19 18(c)(i) 10 11 OP31 OP33 9(2)(b)(i) 24 close enough to eat in comfort. The registered person must have 2 authentic written references in respect of a person prior to them commencing work. Prospective staff must supply an employment record and any gaps must be explained. A staff training programme must be devised to ensure that they receive training appropriate to the work they are to perform. The acting manager must receive training in record keeping and care-planning. Quality assurance audits must be undertaken incorporating the views of residents/their representatives. This is outstanding from 30/09/04 All records must be up to date and accurate. 01/03/06 01/03/06 31/03/06 31/03/06 30/04/06 12 OP37 17 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kingfisher Court Care Home DS0000002206.V279023.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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