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Inspection on 30/04/08 for Kingfisher House Residential and Nursing Home

Also see our care home review for Kingfisher House Residential and Nursing Home for more information

This inspection was carried out on 30th April 2008.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

Kingfisher and Spiller houses provide a secure and comfortable home for service users to live in. The home offers a holistic service in a relaxed and homely setting. Good individualised care and support is offered to the service users following their needs as identified in their individual care plans. Residents spoken with during this inspection were complimentary about the care they receive and the manner in which this is delivered to them. Written pre inspection survey comments told us that; " My relative feels secure and her privacy and possessions are respected". " The laundry maintains a good standard". " The food is much improved, regular and well presented". "Care is excellent ,I am glad that I came here".

What has improved since the last inspection?

Since the last inspection the new manager and management team have established themselves and are now offering stable and focused leadership and management throughout the home. During this past year the home has been subject to a programme of redecoration refurbishment and the provision of new equipment. Staffing levels have been increased for all grades of staff including carers housekeepers and kitchen staff. A new qualified and experienced Chef has been appointed along with extra kitchen staff and a Housekeeper Manager appointed to lead an expanded house keeping team. Extra Activity Coordinator hours are now employed and this has facilitated an expansion in the programme of activities. The new manager has established regular patterns of consultation with residents , relatives and with staff. Care plans and risk assessments have all been subject to major review. The updating and maintenance of the homes records has been improved.

What the care home could do better:

Works to complete the refurbishment of the two older style bathrooms in Kingfisher House must be completed. Improvements are needed to the medication storage areas in Spiller House. It would be advantageous if more staff could access more in depth Dementia Care training.

CARE HOMES FOR OLDER PEOPLE Kingfisher House Residential and Nursing Home St Fabians Close Newmarket Suffolk CB8 0EJ Lead Inspector Mrs Jan Sheppard Unannounced Inspection 30th April 2008 9.45 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 Residential and Nursing Home DS0000024427.V363781.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. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingfisher House Residential and Nursing Home Address St Fabians Close Newmarket Suffolk CB8 0EJ 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) 01638 669919 01638 669929 kingfisher.house@fshc.co.uk Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Peter Walton Manager registration applied for. Care Home 91 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (33), Old age, not falling within any other of places category (62) Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2007 Brief Description of the Service: Kingfisher House, Newmarket, is part of Four Seasons Health Care. The house is purpose built to provide nursing and residential care for a maximum of 91 older people. Kingfisher House has two floors with a shaft lift accessing the first floor. It comprises 58 bedrooms each with en-suite toilet and wash basin facilities. Bathrooms providing assisted baths and shower facilities are situated on each floor along with a number of small lounges and kitchenette/dining areas. A new unit (Spillers) was opened in September 2005 and provides an additional 29 places for people who have dementia. The layout is similar to Kingfisher House in that there are bedrooms and communal areas on both floors. There is a vertical passenger lift for use between the two floors. There is a separate staff team consisting of senior carers and care assistants for this unit. Bedrooms are usually for single occupation although some are of sufficient size to accommodate couples at their request. The main kitchen and laundry provide services to both houses and these along with offices and extra communal lounge areas are situated on the ground floor of Kingfisher House adjacent to the homes main entrance. The fees range between £660 and £835 per week depending on whether a resident has residential needs or nursing needs and the level of dependency within that. Various local Social care authorities and Health authorities sponsor residents in this home. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2*. This means that the people who use the service experience good quality outcomes. This unannounced inspection took place over eight hours during a weekday. This was a key inspection that focused on the key standards of the Care Standards Act 2000 relating to Older People. During this inspection the inspector made a tour of the buildings, had in depth discussions with the homes manager and with a range of other staff on duty, spoke with residents and with a number of visitors to the home. Spot checks were made on a number of the homes records. The detail in this report reflects the findings on that day and also takes account of information sent periodically to the Commission by the homes management. Information contained in the AQAA ( Annual Quality Assurance Assessment) and in a number of pre-inspection surveys completed by residents, relatives, staff and other professionals was also taken into account. In total the Commission received 28 pre inspection survey replies 10 from residents, 8 from relatives, 2 from other professionals and 7 written and one e mailed response from members of staff. Although the inspection was carried out by just one inspector the wording used in the report will refer to “we” as the report is written on behalf of the Commission. What the service does well: Kingfisher and Spiller houses provide a secure and comfortable home for service users to live in. The home offers a holistic service in a relaxed and homely setting. Good individualised care and support is offered to the service users following their needs as identified in their individual care plans. Residents spoken with during this inspection were complimentary about the care they receive and the manner in which this is delivered to them. Written pre inspection survey comments told us that; “ My relative feels secure and her privacy and possessions are respected”. “ The laundry maintains a good standard”. “ The food is much improved, regular and well presented”. “Care is excellent ,I am glad that I came here”. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Works to complete the refurbishment of the two older style bathrooms in Kingfisher House must be completed. Improvements are needed to the medication storage areas in Spiller House. It would be advantageous if more staff could access more in depth Dementia Care training. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 7 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. Kingfisher House Residential and Nursing Home DS0000024427.V363781.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 Kingfisher House Residential and Nursing Home DS0000024427.V363781.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. Standard 6 was not assessed as the home does not offer intermediate care. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that admissions are not agreed until a full needs assessment has been carried out to satisfy that the persons needs will be met appropriately. EVIDENCE: The manager explained that there had been no changes in the homes procedures for pre-admission assessments since the last inspection. All prospective applicants are invited to visit the home, along with relatives if they wish, to view the accommodation to meet with staff and with other residents. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 10 All applicants are then seen in their home (or in hospital) by the manager who may be accompanied by a member of the care staff from the unit which has the vacancy. An in depth assessment is made using the new Four Seasons Health Care Assessment documentation which covers health and social care needs. The four main sections of this are entitled “ Daily Life Skills”, “ Mental Health and Wellbeing”,” Multi professional intervention needs” and “Social needs”. Each area assessed generates a score which then gives a level of physical and mental dependency. This tool is intended for use during further assessments in the home. The manager explained that since the last inspection the home has developed a formal procedure for making a new assessment of any resident that transfers from the Kingfisher to the Spillers Unit. Three files were examined and it was seen that this assessment procedure had been followed and well documented. The homes recently revised Statement of Purpose and Service Users Guide is given to each prospective applicant along with contractual information and a schedule of fees. Information given in the pre inspection surveys from both relatives and residents confirmed that this information is helpful and thorough and that the home had continued to maintain good communication with relatives. “ When needed I can speak directly to the Manager who is always very good responsive and caring in his approach”, comment from a resident. “ A comment from a relative “ Staff are very thoughtful in the way they look after my (relatives) needs and they always keep us in touch with us too.” At the time of this unannounced inspection the home had no vacancies and was holding a small waiting list. Kingfisher House Residential and Nursing Home DS0000024427.V363781.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. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be assured that they will receive a care plan, which is person centred to ensure that staff know what and how to deliver the care required to meet their wishes and goals. The medication procedures are robust and are known to the staff thereby ensuring safety for the residents Better attention must be given to the temperature of the storage areas in the Spiller Unit. EVIDENCE: All the eight care files seen contained a detailed and person centred care plan for the resident which included planned interventions for all assessed needs and was seen to be maintained up to date and to be subject to regular review. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 12 Where possible the involvement of residents and relatives was included in this review. The manager explained that since the last inspection the care plans for all residents have been revised and are now formatted into clearly indexed sections following the Four Seasons guidelines. All areas of care were seen to be recorded consistently and to have risk assessments that were also subject to review. Areas of care including moving and handling, falls, nutrition, weight maintenance and management, skin condition, pain management along with evidence of contact details of other health professionals involved in the care of the residents. Records are kept of visits by GP’s, the chiropodist, Community Nurses and specialist services such as Continence advice. The daily records were seen to give information as to the outcomes of the care plan. For example “ X looks much brighter and is eating better to day”. The management plan for pressure wounds was seen to be well documented with accompanying photographs, measurements and descriptions of the wound healing progress. Advice and assistance from the specialist Tissue Viability service is sought and specialist equipment to assist with good care practice is bought in as required. Regulation 37 reports of pressure wound grades and progress are regularly made to the CSCI. (Commission for Social Care Inspection) The manager confirmed that the homes receives prompt services from a wide range of allied medical professionals and that many residents who have previously lived in the vicinity are able to retain their original known GP if they wish.A comment on a residents survey said “ My GP is always called quickly if I need to see him”. Staff were seen to be interacting with the residents in a calm and kindly manner using their preferred name and respecting their rights and privacy by knocking on doors and asking “ Is this what you would like?” Residents were seen to be responding warmly and several told us that “ the staff are lovely” The home uses an (MDS) monitored dose system for medication storage and administration. This is supplied by a local pharmacist and staff reported that they offered a prompt service with good support and training when required. The nurses who administer medication have all received recent updated training and the MAR (medication administration record ) sheets examined were found to be correctly recorded with no gaps. Explanations for any deviations from the norm were seen to be adequately described on the reverse of these sheets using the appropriate letter code identification. A check was made of the Controlled drugs register and these records were found to tally with the controlled medication held. The home has four secure medication units one on each floor each provided with facilities for the safe keeping of the blister packs and a controlled drugs cupboard. The units in the Kingfisher House are of a good size providing a fridge, a sink, adequate record storage areas and flat working surfaces along with the ability to regulate the temperature. However in the Spillers Unit where two internal cupboards are used these provide insufficient size have insufficient document storage space have no flat working surfaces and provide no facility for temperature control. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 13 Improvements must be made to these facilities so that medication can be maintained at the consistent temperature to ensure its full effectiveness and give proper protection to the recipient residents. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 14 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. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to be encouraged to maintain contact with family and friends and to be able to participate in activities of their choosing. People who use this service can also be ensured of receiving meals which will meet their expectations and nutritional needs. EVIDENCE: All the care plans examined contained evidence of an assessment of the residents interests and activity choices. The manager explained that since the last inspection the hours of the Activities Co-ordinator had been increased so that they now encompass each weekday and some time at weekends and that the range of activities had been greatly enlarged in line with requests from service users. New residents and their families are now routinely asked what interests they have and what activities they may like to participate in. Spot checks made of the activity programme evidenced regular sessions of card Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 15 games, scrabble and bingo along with such new activities as gardening, visits from a” PAT” dog, indoor bowls for the wheelchair bound and manicures. Theme food evenings are now regularly held and a special two week activity programme is planned to cover the Christmas period. Photographs of the popular and successful Easter Bonnet competition along with a special Easter tea were on display. Representatives from several local churches regularly visit the home although comments on one survey said that felt that this there was still insufficient regular spiritual contact. Several others surveys mentioned very positively the regular visits from a local school when pupils spend time talking with individual residents and sometimes give seasonal concerts. Activities are organised for small and larger groups as well as individual sessions for those who respond best to this level of contact.. On the day of this inspection care staff were observed to be facilitating board games for groups of two or three residents in a small lounge in Kingfisher whilst in the afternoon an outside musical entertainer gave a performance in the large lounge to which the whole home were invited. One resident was seen to be returning from an accompanied shopping outing into the local town. The Activities Co-ordinator has recently attended a Dementia Activities training course and the manager reported that he aims to further increase the hours of activity organisation throughout the home so that more time can be given to activities generally and especially to specialist activities on the Dementia care units. The pre-inspection surveys from service users and relatives gave a mixed response, some saying that they enjoyed the varied opportunities to join in with activities one resident confirming that” the entertainment is very good” whilst others said that “ there are not many activities” . Comments from relatives included “ naturally my Mum would like to go out but this does not happen “ “ There does not seem to be a programme of visits or visitors”. and “ My relative would like a more interesting life not just TV and too few activities”. These mixed comments perhaps lend weight to the Managers comment during the inspection that he recognised that the homes activities programme needed to be further developed. Since the last inspection a new Chef Manager has been recruited along with additional kitchen staff of all grades and considerable works of refurbishment to the kitchen have been completed. An Environmental health inspection which took place during February 2008 assessed the kitchen, its facilities, presentation and operating procedures as achieving a rating of 8 out of 9 stars this being an improvement of 7 stars from the previous inspection. The new Chef is qualified and has had many years experience running top hotel kitchens. Since joining Kingfisher he has attended training courses on “Catering in Nursing Homes” and “ Providing Nutrition for Dementia Sufferers.” He has also attended a course on the presentation of liquidised meals in a more appealing way. Following consultation with residents new menus have been compiled and the home tries to source local fresh seasonal produce where ever possible. Menu Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 16 presentation has improved and is very professional but the Manager and the Chef think that further developments with this aspect could be made for example visual menus on the Dementia Units. A red tray service for meals for dementia sufferers whose calorific intake has to be carefully calculated has been introduced this enables the kitchen to monitor the nutritional value of the freshly prepared meal and then to calculate the value of any uneaten portion of the meal returned. Drinks are available throughout the 24hour period and staff were observed to be regularly offering drinks to those residents who could not ask for themselves. Snack Boxes have been introduced for residents who become hungry outside normal mealtimes particularly at night. Comments from residents and staff with one or two exceptions were positive about the food “ it is presented very well tasty and always plenty of it” “We are consulted about the menu now and get better choices”. Critical comments were “ food could be better”,” often the hot food is served onto cold plates” During this inspection the serving of the evening meal on Spillers unit was observed. There was a happy and relaxed atmosphere in the dining room with sufficient staff numbers to allow for each table of two to three residents to have a dedicated member of staff to assist them. Staff were seen to be allowing the residents to eat at a pace that was comfortable for them and to be assisting them in a sympathetic manner helping when needed but allowing the resident to do as much for themselves as they could. Residents who decided to get up during their meal to wander or to make other choices from the cake and sandwich trays were allowed to do so with staff then coaxing them back into their seats and encouraging them to eat .One resident who became anxious about her lost cake tin was accompanied back to her bedroom to search and then assisted back to the dining room to continue with her meal. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 17 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. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to the service. People who use this service can be confident that the policies and procedures in place will ensure that people are listened to and are protected from abuse. EVIDENCE: The complaints policy is clear and appeared to be understood by the staff. Comments on the pre-inspection surveys from relatives also indicated that they understood their right to complain and how the procedures would operate. Residents told us that if they needed to make any complaint they would first talk to their key staff member their nurse or to the Manager. Three complaints have been made since the last inspection and these were seen to have been dealt with following the homes stated procedures and within the required time frames. We were shown a number of complimentary letters which had recently been received by the home. All staff have received training on POVA (Protection of Vulnerable Adults) issues and spot checks on the homes training records evidenced that this Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 18 training is planned to be ongoing. Two POVA incidents have been referred for safeguarding adult investigations since the last inspection. Staff survey replies and answers in discussion with us during the inspection evidenced that they knew and understood the homes POVA and Whistle Blowing policy and procedures and that there was a heightened awareness of their responsibilities concerning protection of the very vulnerable group of residents that they care for. Staff spoken with were clear how to proceed if they had any concerns for the safety of a resident. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 19 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 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to the service. People who use this service will find that it is homely and comfortable and that the design and facilities are appropriate to meet the specific needs of the people who live there. EVIDENCE: Kingfisher House benefits from being recently purpose built to meet the space and facility requirements of the Care Standards Act 2000 National Minimum Standards. The home is spacious and very well appointed and provides a safe environment for its residents. On the day of this unannounced inspection during which all areas of the home were visited it was found to be very clean and tidy with no malodours. All areas are attractively decorated and are subject to a routine redecoration programme. Residents are encouraged to Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 20 personalise their bedrooms and all looked very homely and comfortable. Without exception all comments from residents and relatives were complimentary about their rooms although one adverse comment was made about the quality of the bed linen. Call bells were seen to be readily accessible in all of the bedrooms. Where required door guards are fitted to bedroom doors so that if the resident wishes it these may safely be left open during the day hours. One resident who wanted to show the inspector her room said “ I am very comfortable here; I have privacy; it is all so attractive light and airy and I have beautiful views of the garden” Another comment from a relative “ The staff are plentiful and friendly to both my relative and my family. It is a great comfort when I visit I feel her room is a bolthole from everything and we both relax and enjoy quality time together”. Since the last inspection a number of works of refurbishment and improvement of the homes facilities have been carried out and this programme is continuing. New flooring has been provided for the first floor corridors lounge and dining room and also in the ground floor dining room. Over thirty new profiling beds with integral bumper protectors have been purchased and residents told us how they appreciated the space and comfort these provided. Redecorations have been completed in many bedrooms and the home now has a programme of regular redecoration of all bedrooms. Some bedrooms have also had new furnishings although this refurnishing programme is not yet complete in Kingfisher house. Two bathrooms in Kingfisher have been refurbished with more modern assisted bathing and shower facilities and similar works on the two remaining bathrooms are planned. The kitchen has been subject to a number of refurbishment works including new flooring and purchase of equipment and the successful completion of this and the subsequent maintenance of a high standard of cleanliness is reflected in the recent award of 8 stars following an Environmental Health inspection. According to the information given on the pre inspection surveys the laundry provides a very good service prompt and reliable and we noted during our visit that all residents clothing was very well presented. Although the laundry is well equipped and has adequate dedicated staffing the manager said that he is considering extending the hours it operates so that the increasing pressure on maintaining a good standard for this service can be accommodated. Laundry staff demonstrated a good awareness of infection control measures with red bags seen to be being used for all soiled linen. During this inspection the House Keeping Manager introduced us to some of her staff and told us of some of the improvements made to this service since the last inspection. The staffing levels are now stable and all staff now have the use of especially designed equipment trolleys and new carpet cleaning equipment is enabling them to achieve a better standard. Alcohol Gel Dispensers are now available throughout the home (for staff and visitors)and there are now always adequate supplies of cleaning materials. During this Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 21 inspection we saw that the home was being kept very clean with good attention to detail for example window cleaning and tidying of cupboards residents rooms. The home had a fresh smell and clean appearance throughout. Comments from residents confirmed their satisfaction with the service. One told the inspector “The girls who clean my room are so friendly and thorough and will do little cleaning jobs to help me with what I cannot now do for myself and as you can see I have a lovely room “ she said. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 22 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. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that they will be supported by skilled and trained staff who have been robustly recruited to ensure their safety. The home has an appropriate number of staff to support the people who use the service and to ensure the smooth running of the home. EVIDENCE: The manager explained that since the last inspection additional staff of all grades including carers, house keeping and kitchen staff had been employed in the home and that the home was now fully staffed so that agency staff do not know have to be used. The staff rotas evidenced that there are sufficient staff of all grades on duty at all times to meet the assessed needs of the residents. Each floor of the home has at least one trained nurse on duty throughout the twenty four hour period assisted by teams of carers housekeepers laundry and kitchen staff along with the homes maintenance caretaker. Staff spoken with during the inspection told us that staffing was now quite good and residents and relatives spoken with praised the staff and the attentive way in which care was given. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 23 Comments on the pre inspection surveys were however somewhat mixed but told us that; “ Staff are plentiful and friendly” “There is a nice atmosphere in Kingfisher House the staff seem to get along well together and co-operate” “ The carers are kind and helpful” “Excellent care” “ There are inevitable mix ups due to staff shortages” “ There are now fewer English speaking carers.” “ The basic problem seems to be insufficient staff” “Good staff are frequently distracted by other demands” The manager told us that he visits the home before 7 am at least twice a week so as to be able to meet with the night staff to keep them and himself informed about the pressures of their night duties and to offer them support and inclusion in the news and running of the home. The manager confirmed that English is the only language spoken in the home by the staff at all times and that this rule applies to all areas of the building. The recruitment files for three new staff were inspected and all were found to contain all the required identification, security and CRB checks made before the person commenced in post. Staff confirmed the thoroughness of the application and interview process and the fact that initially they worked shadowing an experienced member of staff and that their induction programme commenced promptly and was ongoing. The home currently employs fifty six care staff of which thirteen hold NVQ at level2 or above and six more are working towards this. Several staff told us that they were waiting to commence this training. The manager reported that he hoped that the required 50 of carers holding NVQ at level 2 could be achieved during the next year. All staff told us that they felt well supported working in the home and had good training opportunities. Individual training needs are identified during staff supervision meetings and from this information an annual training programme can be compiled for the whole home. Spot checks on this training programme evidenced that all staff have completed Dementia Care training of varying duration, staff on Spillers will complete more in depth training and it is planned that more senior staff complete the dementia Mapping course. All the kitchen staff have now completed Food Hygiene training. A number of staff were spoken with at random during this inspection all said that they understood the inspection process and said that they knew how they could contribute to this, by either completing a pre-inspection survey questionnaire or speaking directly with the inspector. They said that they were happy to contribute freely to the inspection process and felt that they could say what they felt about the service. Staff told us that they felt well supported by the homes management and that recent changes had bought improvements to the home. Several staff commented positively about the varied training opportunities that they now have. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 24 Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 25 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): 31,33,35 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to the service. People using this service can be assured of a sound management approach led by an experienced and trained manager who leads a service run in the best interests of its service users and which encourages independence and choices. People using this service can be confident that they are safe guarded by the homes good maintenance of its safety checks and procedures. EVIDENCE: Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 26 Following a period of several years of many changes of manager and instability in the management team the new manager has now been in post for thirteen months and has already made application to the Commission for registration. He is an experienced manager having had over twenty years experience of home management. He is a registered nurse (RGN )and holds the qualification D32 as an NVQ Assessor and has recently completed training in Dementia Mapping. He is currently completing NVQ at level 4 in Management. He is supported by a registered general nurse as the Deputy Manager and a full time administrator. The management ethos of the home is one of openness and very clearly to put the needs of the service users first. To achieve this the manager explained that a number of management changes and re emphasis on standards and procedures had been made during this past year. One such measure is the introduction of the daily 10 @10 meetings when the senior team on duty meet together to exchange information keep each other informed about happenings in the home and to share concerns and aspirations for that day and beyond. This information is then cascaded down to all staff throughout the home and these meetings are proving to be an effective way of establishing a good daily focus for all the staff. They may also be contributing to the relaxed atmosphere in the home. Comments received from relatives and visiting professionals confirmed that the manager and his team were always very approachable listened to problems and tried to sort these out quickly. A relative commented” I am always made to feel welcome when I visit the home.” The records evidenced that a supervision matrix is in place to ensure that all staff receive formal supervision at least six times a year. Staff spoken with confirmed that they felt themselves to be well supervised and managed and that they could speak to the manager at any time. The manager explained that further training for the supervising staff was planned for later in the year. Spot checks were made on the records of the regular staff meetings and these were seen to be well attended. The records evidenced that regulation 26 visits are regularly made to the home by the Company and the Manager confirmed that over this past year he has been well supported by them in every respect and that this fact has contributed very positively to the many improvements and changes that have been bought about in the home over this period. Quality Assurance systems are in place and a recent quality audit of the home carried out during March by the company Four Seasons rated it as achieving 83 .This being a considerable improvement on the previous audit and evidences that the manager is proactive in addressing quality issues within the home. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 27 At a previous inspection the system for managing the residents personal monies had been found to be satisfactory and the manager and administrator confirmed that the system and procedures remain the same. With an increasing number of residents being privately funded many are now managing their own finances or are doing so with the assistance of a financial advisor or solicitor. However at admission all residents are asked how they wish to make occasional payments and for those who wish it the home will keep safely small sums usually only up to £300 for them. Others who are capable are encouraged to manage their own monies safely; every resident has a lockable facility in their own room. The records of any monies kept along with expenditure and receipts are maintained by the home copies of these accounts are available for the resident and these are subject to Audit and spot checks carried out by the Four Seasons Administration Manager. A number of records spot checked randomly during this inspection were found to be correctly and accurately kept. Scrutiny of the records relating to Fire Testing, the monitoring of water temperatures, risk assessments for the environment and safety checks of the homes equipment found these to be maintained up to date with evidence of corrective action being taken where standards were not achieved for example the monitoring and adjusting of hot water temperature regulators. The homes health and safety records are well maintained this giving protection for the service users. Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 28 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 2 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 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? no 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 OP9 Regulation 13 (2) Requirement The manager must ensure that the temperature of all the areas used for the storage and administration of medication can be maintained within safe limits to ensure the full efficacy of the medication and give safety to the residents. The manager must ensure that the facilities and design of the bathrooms fully meet the needs of all the residents and ensure safety for the staff who work in them. Timescale for action 31/07/08 2. OP19 23 (2) (a) 30/12/08 Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 30 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 Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Kingfisher House Residential and Nursing Home DS0000024427.V363781.R01.S.doc Version 5.2 Page 32 - 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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