CARE HOMES FOR OLDER PEOPLE
Kingfisher House 171 Yardley Green Road Bordesley Green Birmingham West Midlands B9 5PU Lead Inspector
Jill Brown Unannounced Inspection 25th November 2005 08:40 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 House DS0000063702.V268967.R01.S.doc Version 5.0 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 House DS0000063702.V268967.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kingfisher House Address 171 Yardley Green Road Bordesley Green Birmingham West Midlands B9 5PU 0121 753 0333 0121 771 4190 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) Methodist Homes for the Aged Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Terminally ill over 65 years of age (38) of places Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. That the Home can accommodate 38 service users who are older people (over 65 years of age) and people over 60 years of age with a terminal illness. That the home can accommodate two named service users under 65 years of age who have physical difficulties. 2nd August 2005 Date of last inspection Brief Description of the Service: Kingfisher House Nursing home is a purpose built, single storey home and provides nursing care for up to 38 older people. It is situated in a residential area within the boundary of Heartlands Hospital. It is close to shops and local amenities and is accessible to public transport. The home is warm and homely and furnished to a high standard. It is very well maintained, with pleasant wellmaintained private gardens to the rear of the property. There are adequate parking facilities at the front of the building. Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection in November took place as a result of a complaint about the home that involved some adult protection issues. The inspection took place over nine hours. A previous inspection that took place in August has yet to be reported due to the inspector’s ill- health and in some respects will be superseded by this report. Reports of both inspections this year should be read together. The inspector looked at four resident records and took away copies of another resident’s records for further analysis. Accident and complaint records were seen. Two staff files were looked at. Some policies specific to the complaint were reviewed and residents’ financial records were looked at. The inspector spent time with the care manager, assistant manager and administrative assistant and she spoke with 2 residents and viewed some areas of the home. What the service does well: What has improved since the last inspection? What they could do better:
The home has had a series of changes in the last year. A change of ownership, manager and policies and procedures amongst these. Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 6 The new systems the provider is putting into place has not had time to become usual practice and in some instances there are serious gaps. The homes admission of residents needed improvement to ensure that residents were assisted to settle in the home. The provision of a clear admission procedure would assist this. The residents of this home sometimes have very complex health and emotional needs, a number having a terminal illness. The home failed to ensure that they assessed every area of resident’s potential need or planned for how these needs were to be met. To do this properly no more than one resident should be admitted on any day to the home. There were failures in the planning of care and in ensuring practically that instructions on how care was to be delivered was available to all staff delivering the care. As residents quite often had deteriorating conditions it was important for staff to check before attempting to move or give care to residents on a routine basis and this was not part of the home’s process. The home was failing to give enough support to residents’ emotional and palliative care needs and on one occasion had not consulted the resident or their representative about behaviour that may shorten the resident’s life and prevented the resident getting appropriate pain relief. The home did not have adequate monitoring systems in place to ensure that residents’ care needs were in place; such as charts for those residents that need turning during the day or night. The home also said that they communal records such as shower books and bowel records and these must be individualised to the resident. Although medication was not assessed on this occasion one resident’s records showed gaps in recording a number of medication administration without a reason being given. Requirements were brought forward from an inspection in January. The home had an issue of adult protection and investigated this contrary to the home’s procedures. The investigation and subsequent complaint to the Commission highlighted the areas shown above. The home’s handling of the investigation was poor and the response to the complainant extremely poor. The areas are of serious concern and the Commission is taking action on these matters. The homes customer survey and an assessment of the dependency of residents suggested that the homes staffing levels need to be adjusted. The home need to consider how the home is covered for staff at the peak times of residents need such as assisting residents in the morning. Staff records needed to be improved to demonstrate clear supervision, training and performance management. Training needed to be given to staff in infection control and palliative and terminal care.
Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 7 The home was in the process of big changes. All changes to systems, policies and procedures needed to be discussed with staff and evidence kept of these discussions. The home needed to ensure that the staff act in a consistent way to keep residents safe and management must monitor and improve the care given. 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 House DS0000063702.V268967.R01.S.doc Version 5.0 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 House DS0000063702.V268967.R01.S.doc Version 5.0 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 & 5 Arrangements for giving information and planning admissions to the home needed improvement to ensure that residents are confident in the home. EVIDENCE: The new owners (Methodist Homes) of Kingfisher Nursing home have produced a statement of purpose but this has not been fully adapted to reflect the registration categories of the home or the service the home offers. New residents at the home were admitted quickly with assessments often undertaken on the day of admission. Records of the home’s preadmission assessments or preadmission visits to the home were not found. More than one resident was admitted into the home in a day. Residents admitted to this home can have very complex health and social care needs. The home was changing its methods of assessing residents and therefore paperwork was not consistent. Residents had key areas of assessment of need not completed until after being the home some time such as Waterlow assessments for skin integrity.
Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 10 Some information was not collected routinely that is part of the standard such as oral care and this then became a gap in the care plan. This lack of planning can potentially put residents at risk. The home must develop a procedure that ensures that residents are admitted in a way that protects the resident’s safety and addresses their concerns when moving into a residential environment. Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 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 & 11 The arrangements for care planning and monitoring physical and emotional health were variable. This lack of consistency potentially puts residents at risk. EVIDENCE: A resident did not have a thorough care plan until a number of weeks following admission. There was a lack of detail in personal care plans in areas such as mouth care and how washing and dressing was to be undertaken for each resident. These matters were part of a complaint and this complaint was upheld. Care plans were inconsistent for example in one situation the plan clearly stated that a pressure area was to be photographed weekly. There was a gap of a number of months between the dates of photographs being taken. Wound assessments and wound charts were also not completed as often as good practice would suggest and this could put residents at risk. Information on records was not corrected where it was likely mistakes had been made for example a resident’s height of 4 feet 2inches and a drop in weight of 10 kilograms over a month for a resident.
Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 12 Care staff in the home undertook personal care and moving and handling of residents. Care planning and reassessment were undertaken by nursing staff. Up to date instructions of how hygiene care was to be delivered were not detailed enough to give clear instructions to care staff or near enough to the resident to be a working document. There was lack of monitoring charts for identified health or care issues. These charts included turning, fluid intake and seizure charts. Records were not kept of refusals to receive necessary care. Bedrails were not being appropriately being assessed for. For example one resident had bed rails in place although it was clear that they had attempted to get out of the bed previously and subsequently were found standing on the bed with bed rails in place. This puts the resident at higher risk. The home had excellent assessments and plans undertaken by the physiotherapist on moving and handling and the maintenance of mobility. However these plans were lost amongst all the paperwork and were not contained on the same format as other parts of the care planning process. Moving and handling instructions, were not near enough to resident to ensure that this was checked by care before care was given. The moving and handling of a resident was part of the complaint. Residents spoken to and viewed on the day of the inspection appear to have had their personal hygiene needs met, were appropriately dressed and appeared content. Medication charts were viewed for a resident as a result of a complaint and these medication administration records showed gaps in recording. The management of resident’s emotional needs especially those residents that have a diagnosis of a terminal condition was poor. There appeared to be no planning about this. One resident was taking action that denied them pain relief so they did not prolong their life and this had not been addressed. The Commission is taking action about the issues raised in the care planning, meeting health care needs of residents. Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 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): EVIDENCE: These standards were not assessed on this occasion Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Arrangements for the protection of residents and complaint resolution were poor and this potentially puts residents at risk and increases residents’ dissatisfaction with the home. EVIDENCE: The home has complaint and adult protection policies in place but in practice these have not been adhered to. A complaints form has been developed. A comment and suggestion book held by the home had four comments in it. Outcomes from the suggestions made needed to be recorded. One of these comments was a complaint and this should be separately accounted for in a complaints log in addition to the entry in the comment and suggestion book with appropriate investigation outcome and actions recorded. The home had received an allegation of abuse and this was investigated contrary to the homes adult protection procedures which state that it is between social services and the police to decide if an investigation is to take place. An inappropriate referral was made to the Protection of Vulnerable Adults register, as the register was not given the name of the suspended person. The home did not ensure an adult protection strategy meeting was held. The Commission has received a complaint about this. Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 15 The treatment of a resident remains under investigation, elements of the complaint are reported under care planning (standard 7), monitoring of health care needs including fluid intake and oxygen monitoring (standard 8), palliative and psychological care needs (standards 8 and 11), practical moving and handling needs (standard 8) and staff behaviour (standards 29 and 31) Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 & 37 The management of the home has many changes in the last year and new all new systems must be shared with the staff group to ensure safety of the residents. Residents’ money was accounted for appropriately. EVIDENCE: The environment of the home was not inspected fully on this occasion. The areas of the home seen were clean and fresh. Bedrooms seen for particular residents were well maintained. Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 17 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): 27,29 & 30 Arrangements for performance management and staffing levels in the home needed to be improved to ensure good care for residents. EVIDENCE: The staffing in the home was stated as 2 nurses and 7 carers on the 8am until 8pm shifts and 1 nurse and 3 carers on the 8pm until 8am. The manager and 12 hours of the deputy manager were in addition to this as were ancillary staff such as cooks and cleaners. Rotas supplied by the home suggested that relief staff were used routinely for both nurse and carer cover. A quick audit of dependency suggested that many residents have needs that require assistance from two staff. Comments from the homes internal audit suggest that staffing needed increasing to give residents access to staff when needed and to increase access to interests and activities. Staff records seen were poor and did not reflect a clear record of staff’s employment from recruitment to appraisal, supervision and where necessary performance management. The deputy manager has been given some time to work in improving systems, training and bedding in new paperwork and this was needed to ensure standards are met. The home kept a matrix of staff performance on training on the mandatory required training not all staff had the required training such as moving and handling although it was clear that the home were gaining training.
Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 18 First aid, infection control and palliative care need to be added to reflect the home’s registration. Staff files did not always carry copies of the certificates staff had achieved. Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 & 37 The management of the home has many changes in the last year and new all new systems must be shared with the staff group to ensure safety of the residents. Residents’ money was accounted for appropriately. EVIDENCE: The home has been recently acquired by Methodist Homes, the care manager is new to the home and systems of recording are also changing. These changes have the potential for difficulties in the management and performance of the home. The service provider and manager need to clarify its expectations on standards of care, paperwork and procedures to ensure that the home does not lose sight of its aims and objectives. The home had improved the management of residents’ money since the last inspection. A clear record was being kept along with receipts for any spending of resident’s money. Some suggestions were made for the ease of administration and these were well received.
Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 20 Records for residents must be clearer and staff delivering care must have clear detailed instructions for its safe delivery. Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X 1 N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 X 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X 2 X Kingfisher House DS0000063702.V268967.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1) Requirement The home must revise the its statement so as to provide the detail required by schedule 1 of the Care Homes Regulations 2001 and that it reflects the homes Registration Certificate and its Conditions of Registration. Copy of the revised statement of purpose must be sent to the Commission by The home must cover all areas of assessment required by the standard prior to admission. The home must provide the Commission with its admission procedure and emergency admission procedure. The home must not admit more than one resident on a day unless the two residents have been living together prior to admission. Timescale for action 28/02/06 2 OP3 14(1)(a) 28/11/05 3 OP5 Sch 1(8) 30/11/05 4 OP5 13(4)(c) 28/11/05 5 OP7 15(1) 28/12/05 All residents must have a care plan on admission into the home, unless unusually admitted in an
DS0000063702.V268967.R01.S.doc Version 5.0 Page 23 Kingfisher House emergency. 6 OP7 15(1) All service users care plans must accurately reflect the current needs of the service users. (Outstanding since Jan 05) rewritten as The home must ensure that residents’ care plans covers all areas of identified need from the assessment. 7 OP7 15(1) Personal care/ hygiene plans must be in enough detail and available to care staff for them to be able deliver the care appropriately. Actions taken by staff at the home must be reflected in the care plan to give consistent care. Moving and handling assessment and subsequent plans must be available to care staff to read prior to each move. Monitoring charts must be available for care given, such as turning and bathing. Monitoring charts must be in place for residents that have identified needs such as seizures, timed monitoring for minimising identified risks, fluid charts and so on. Communal books for monitoring bowel movements, showers and so on must be dispensed with. 28/12/05 28/12/05 8 9 OP7 OP8 12(1)(a) 13(5) 28/12/05 28/12/05 10 11 OP8 OP8 12(1)(a) 12(1)(a) 28/12/05 28/12/05 12 OP8 Data protection Act 15/12/05 13 OP8 14 OP9 13(4)(c) & Residents that need bedrails must have an assessment to (7) ensure that their use does not increase the risk of injury. Regular staff drug audits must 13(2) be performed to confirm the validity of the Medicine Administration Record (MAR) charts. Appropriate action must be taken when discrepancies are
DS0000063702.V268967.R01.S.doc 31/12/05 31/01/06 Kingfisher House Version 5.0 Page 24 15 OP9 13(2) 16 OP9 13(2) 17 OP9 13(2) 18 OP11 12(3) 17 18 20 OP16 OP18 OP27 22(3) 13(6) 18(1)(a) 21 OP29 Sch 4 (6) 22 OP30 18(1)(c) (i) found. (This standard was not inspected on this occasion and were brought forward.) All prescriptions must be seen prior to dispensing, checked and a system installed to check the dispensed medication and Medicine Administration Record (MAR) chart against the prescription for accuracy. (This standard was not inspected on this occasion and was brought forward.) No cancellation, obliteration or alteration may be made in the Controlled Drugs Register; correction must be by dated marginal note or footnote. (This standard was not inspected on this occasion and was brought forward.) There must be no gaps in the MAR if medication is not given the reason for this must be recorded. Residents’ emotional needs must be considered especially those with a terminal illness. Identified staff time and support must be in place. The home must improve their complaints investigation process and recording. The home must follow their adult protection procedure. The home must consider its staffing levels against the dependency of its residents and peak periods of activity. Staff records must include supervision records, qualifications and reports of all performance management. The home must ensure that all care and nursing staff are given training in aspects of palliative care and infection control.
DS0000063702.V268967.R01.S.doc 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/02/06 Kingfisher House Version 5.0 Page 25 23 OP37 13(4)(c) All new policies and procedures must be discussed with the staff group and evidence must be retained. 31/02/06 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 House DS0000063702.V268967.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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