Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 04/05/07 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 4th May 2007.

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

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

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

What the care home does well

A new dependency assessment tool has been introduced for use during a preadmission assessment and any further assessment undertaken when a resident is admitted to the home. The tool, when completed correctly, contains a lot of information to help staff plan support for the resident to meet their needs, as they would wish. Residents spoken with all said staff are willing and kind. Comment cards received from relatives prior to this inspection also say staff are friendly and make visitors welcome.

What has improved since the last inspection?

A number of corridors and communal rooms have been redecorated and look fresh and less cluttered as the large number of pictures the home had have been reduced. Residents` rooms are redecorated as they fall vacant so a number of them have been repainted too. Four Seasons Health Care have appointed a permanent manager who has a lot of experience in management of care homes. The service has also appointed a housekeeper manager so the ancillary staff have a line manager. A programme of staff training and supervision has been re-instated and training needs are identified and addressed. The management, recording and administration of medication have improved allowing an audit trail for medicines. A daily communication meeting called `10 at 10` has been established for senior staff to hand over any issues or concerns relating to any of the residents. Any resident whose health needs changed would be identified during this meeting.

What the care home could do better:

Some environmental areas need to be addressed. The carpet in the downstairs dining room in Kingfisher is very badly stained and needs replacing. Some bathrooms in Kingfisher are gloomy and shabby with stained floor covering and chipped wall tiles. Odour control in Spillers could be better. Some bedroom furniture such as bedside tables needs replacing, as they are very chipped. A recent visit from an environmental health officer identified serious shortcomings in the cleanliness of the kitchen. Requirements made as a result of that visit need to be actioned. Evidence should be available that a re-assessment of need has been done for a resident whose health needs change and requires care in Spillers rather than Kingfisher. After a transfer between the two parts of the home new care plans should be generated to reflect the change in dependency. The care plans seen in Spillers did not have specific interventions in relation to the residents` dementia needs. Some instructions on MAR sheets in Spillers were not correctly followed. Daily records in Kingfisher were not informative. A number of residents and staff expressed concern that the food was unimaginative. Staff files seen did not contain all the evidence of recruitment checks being carried out. Some mandatory training for staff needs updating. Some instructions on MAR sheets were not correctly followed when administering medication.

CARE HOMES FOR OLDER PEOPLE Kingfisher House Residential and Nursing Home St Fabians Close Newmarket Suffolk CB8 0EJ Lead Inspector Jane Offord Unannounced Inspection 4th May 2007 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 House Residential and Nursing Home DS0000024427.V339375.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.V339375.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) Manager post vacant 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.V339375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 2006 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 62 older people. Kingfisher House has two floors with a shaft lift accessing the first floor. The home has a lounge on each floor, a smoking room and a laundry room situated on the ground floor. Both floors have separate dining rooms, which are available for service users to eat their meals. There are 58 single bedrooms and four shared rooms each having the advantage of an en suite toilet and wash basin, shared bathrooms are situated on each floor. 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. Admissions have been made to both floors now although the facility is not yet full. The ground floor is for people with dementia who can be cared for in a residential setting. The first floor is for people with dementia who require nursing care and the staff team reflects that. Meals are transported from the main kitchen. There is a separate staff team consisting of nurses, senior carers and care assistants. The fees range between £520.00 and £700.00 per week depending on whether a resident has residential needs or nursing needs and the level of dependency within that. The fees do not include newspapers, chiropody, hairdressing, transport or toiletries. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection looking at the core standards of care for older people took place on a weekday between 10.00 and 18.00. The manager was available for part of the day and returned to the home for feedback at the end of the inspection. Other staff assisted with the inspection process as well. This report has been compiled using information available and evidence found during the inspection. During the day all parts of the home, both Kingfisher House and Spillers Wing, were visited and a number of residents and staff spoken with. Care practice was observed throughout the visit. A number of residents’ files and care plans were sampled in Kingfisher and Spillers and a variety of other documents were inspected including medication administration records (MAR sheets), the controlled drugs (CD) register, the complaints log and some staff files. On the day of inspection residents were using all areas of the home and visitors were seen to come and go. Interactions between staff, residents and visitors were friendly and appropriate. The home looked clean but some of the furniture and carpets are worn and looked shabby. The ground floor in Spillers had an unpleasant odour apparent on entering. Residents in both parts of the home looked comfortable and were well dressed. What the service does well: What has improved since the last inspection? A number of corridors and communal rooms have been redecorated and look fresh and less cluttered as the large number of pictures the home had have been reduced. Residents’ rooms are redecorated as they fall vacant so a number of them have been repainted too. Four Seasons Health Care have appointed a permanent manager who has a lot of experience in management of care homes. The service has also appointed a housekeeper manager so the ancillary staff have a line manager. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 6 A programme of staff training and supervision has been re-instated and training needs are identified and addressed. The management, recording and administration of medication have improved allowing an audit trail for medicines. A daily communication meeting called ‘10 at 10’ has been established for senior staff to hand over any issues or concerns relating to any of the residents. Any resident whose health needs changed would be identified during this meeting. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 7 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.V339375.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.V339375.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, 6. Quality in this outcome area is good. People who use this service can expect that admission will be based on sufficient information to make an informed choice and an assessment of need. The service does not offer intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of six residents in Kingfisher were seen and two in Spillers. All six in Kingfisher and one of Spillers had completed pre-admission assessments. The assessment tool is new documentation introduced by Four Seasons Health Care and covers health and care needs in depth. There are four main sections with each section having multiple areas for assessment. The four headings are ‘Daily life skills’, ‘Mental health and wellbeing’, ‘Multiprofessional intervention needs’ and ‘Social needs’. Each area assessed generates a score that are all added to give the level of dependency, physical, mental or both, of the resident. The tool is intended for use at further assessments in the home. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 10 The file in Spillers with no pre-admission assessment was for a resident who had recently been admitted there from Kingfisher. Their mental health had deteriorated and they needed specialised care. There was documentary evidence that they had been visited prior to the transfer but no record of a reassessment and the dependency score had remained the same since last November. In discussion with the manager the need for a formal procedure for the transfer of residents between the parts of the service was highlighted and agreed. Kingfisher House Residential and Nursing Home DS0000024427.V339375.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, 10. Quality in this outcome area is adequate. People who use this service can expect to have their wishes about their care respected but cannot be assured that their care plans will reflect all their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The eight files seen all contained a care plan for the resident. One resident in Spillers who had recently been transferred from Kingfisher did not have an updated care plan but staff were using the care plans from Kingfisher and there was evidence they had been reviewed by Spiller’s staff. However there was no evidence of the deterioration in health that had necessitated the transfer being reflected in the care plan interventions. The other care plan for Spillers had interventions for personal hygiene, mobility and swollen legs but nothing specific for needs arising from the dementia diagnosis such as poor memory, communication problems and the need to wander, all of which had been identified in the pre-admission assessment. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 12 The files all had risk assessments for areas of care such as moving and handling, skin integrity, nutrition and falls. Some files also had pain assessments if pain management was a care need. One resident with extensive leg ulcers and a pressure sore had good documentation for the management of the wounds accompanied by photographs, measurements and descriptions of the wound progress including, ‘sore now healed’. There was evidence in all the files of contact details of health professionals involved in the care of the residents. Records were kept of visits to and by professionals such as the GP, chiropodist, community nurse and specialist nurses such as the continence advisor. One resident spoken with said the staff were very supportive if there was a health problem and responded quickly if a resident wanted to see their doctor. Regulation 37 reports received by CSCI show that emergency services are called out if staff have concerns about the health of a resident following a fall. The daily records in Kingfisher do not give information about the outcomes of care for residents. They record personal care given but no information about the resident’s mood or behaviour. For one resident the care plan recorded that they liked to have a weekly bath and the records showed that was happening. Another resident had had identified in the pre-admission assessment that they ‘enjoyed a regular bath’ but although they had been in the home for nearly ten days there was no record that they had had, or been offered, a bath. The daily records in Spillers were much fuller and gave details of the residents’ pastimes and moods as well as personal care delivered. Observation throughout the day showed that carers spoke respectfully to residents, offering them choice about where the wanted to be and what they wished to do. Staff knocked on doors before entering rooms and asked residents permission before performing any task in the room. The home uses a monitored dose system (MDS) for managing medication. The local pharmacy dispenses medicine into blister packs that are supplied to the home monthly. One nurse spoken with said the pharmacist had had a lot of training input with the nurses about medication administration. MAR sheets were checked in Kingfisher and Spillers. No signature gaps were noted and codes were used correctly if medication was not given or refused. One MAR sheet in Spillers had a record that eardrops that were prescribed for seven days had been administered for sixteen. Another instruction on a MAR sheet was for a medication to be given once daily. The MAR sheet showed that it was omitted every seventh day. In discussion with the deputy manager it was because the medicine reacted with another medication given once a week. It was agreed that under those circumstances the instructions should be made clearer. The controlled drugs (CDs) register was seen in Kingfisher and stocks checked against the records. They tallied with the register. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. People who use this service can expect to be encouraged to maintain contact with family and friends but cannot be assured that meals will meet their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The eight residents’ files seen all contained contact details of next of kin and who to contact in an emergency if that was a different person. CSCI received six relatives comment cards prior to this inspection. Two of them said they were always kept updated with their relatives’ condition and four of them said they usually were. Relatives spoken with said they were made to feel welcome in the home and could visit at any reasonable time. They had recently been invited to a meeting to look at the service offered by the home. The home employs an activities co-ordinator who has been in post for a couple of months. They are organising activities each day and alternate between using upstairs and downstairs lounges. Residents from either floor can join any of the activities if they wish. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 14 The co-ordinator said residents enjoy card games, Scrabble and bingo. They sometimes find it difficult to get residents together as people that have mobility problems have to rely on carers to bring them to the lounges and often carers are busy. Entertainers are frequently booked and residents from Spillers join Kingfisher residents in the lounges for that. School children from a nearby school visit weekly and spend time talking with residents who enjoy the youthful company. The home also uses the ‘pat dog’ scheme. On the day of inspection the co-ordinator had organised some residents to plant up hanging baskets that were to go into the courtyard in the centre of the building. In discussion with staff it was said that a church service is held at the home monthly but there are no other regular spiritual contacts. The comment card from one relative specifically remarks that, ‘not enough attention appears to be paid to religious faith’. The manager agreed this was an area of social care that could be explored and expanded if that was what residents wished for. Daily records in Spillers recorded activities participated in by the residents but these were often organised by the carers. The co-ordinator does visit Spillers when they can but have not had any training in working with people with dementia. The meals are offered on a four-week set menu. There is a cooked breakfast available each day and lunch has a choice of two main dishes and two desserts. There is a full roast dinner every Sunday and hot snacks, soup and sandwiches for tea each day. One resident spoken with at mid-morning said they had just had coffee made with milk and two biscuits, one of which had been chocolate. Staff were observed during the day replenishing water jugs and glasses for residents. Some staff said they thought the food was unimaginative and could be improved to encourage residents to eat more. They had concerns that some residents with small appetites did not get sufficient nutritional content from their meals particularly the liquidised meals. From four ‘have your say’ comment cards received from residents before this inspection one says meals could be improved, two say they sometimes enjoy the meals and one says they usually enjoy the meals. The kitchens were visited and looked clean although the floor covering was old and did not join in places making it difficult to keep thoroughly clean. The manager said that a full clean of the kitchen had been done following the recent visit by the environmental health officer when the level of hygiene had been judged to be completely unacceptable. Temperatures of refrigerators and freezers showed they were functioning within safe limits for food storage. The food stores had a wide selection of dry, frozen and fresh foods correctly stored. The cook said that it is hard to produce meals on the budget permitted and they are aware that they exceed the allowance at times. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. People who use this service can expect to have concerns taken seriously and be protected from abuse by staff knowledge. This judgement has been made using available evidence including a visit to this service. EVIDENCE: CSCI are not aware of any complaints about this service since before the last inspection. The complaints log was seen and showed the home had received one complaint about care given to a person having respite. There was evidence of a full investigation and the complainant was kept informed of the progress. A written response was sent to the complainant at the end of the investigation and the complainant responded in writing thanking the manager for looking into their concerns. CSCI received three staff comment cards, four residents’ cards and six relatives’ cards prior to this inspection. Only one relative ticked that they were unaware of the home’s complaints policy. One relative said they had not had to complain as requests were ‘executed effectively’. A recent POVA referral was made by an external agency in respect of the care of a resident who was admitted to hospital from Kingfisher. The strategy meeting investigated the concerns and concluded no further action was required as the concerns were not proved. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 16 Updated training on POVA issues is being accessed by staff again. There had been a period when staff training had slipped but that is now being addressed. POVA is covered in staff induction, during dementia training and in NVQ 2 instruction however this still leaves a number of staff who need to be updated. Staff spoken with were clear about how to proceed if they had any concerns for the safety of a resident. The home has a whistle blowing policy to protect staff who raise any issues about colleagues. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26. Quality in this outcome area is adequate. People who use this service can expect to have comfortable rooms but cannot be assured that bathrooms are well-maintained, that carpets are in good condition or that unpleasant odours are controlled. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All parts of the home were visited in the course of the day. Some communal rooms and corridors have been repainted since the last inspection. Corridors look less cluttered as the numerous pictures that were hung along them have been severely culled. The ones that remain have suitable subject matter and look attractive. Two of the downstairs bathrooms that were seen were gloomy with no natural light and poor overhead lighting. The floor covering was old and stained and in one bathroom some tiles had been broken off the wall. The manager said these rooms are earmarked for upgrading. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 18 Residents’ own rooms were personalised with photographs and ornaments. One resident spoken with said they enjoyed being in their room and looking over the garden. They watched the birds and sometimes saw squirrels. Some furniture in residents’ rooms looks in need of replacement in particular some small tables that are very chipped and scratched. The carpet in the downstairs dining room is very stained and unattractive in spite of regular cleaning. Spillers was visited during the afternoon. Everywhere was clean and tidy but there was an odour of urine apparent on entering the ground floor. Residents were using the lounges or safely wandering in the corridors. Records of water temperatures were seen and showed they were regulated to near the recommended 43 degrees centigrade. The laundry was visited and looked busy. Staff spoken with were able to explain the procedure for the management of soiled linen and said they had protective clothing available for tasks that had a risk of cross-infection. The washing machines have a sluice wash programme. Hand washing facilities were supplied with liquid soap and paper towels. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. People who use this service can expect to be supported by adequate numbers of staff but cannot be assured that they have all the updated training needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The trained nurses in Kingfisher tend to work on one floor and manage a team of carers who usually remain on the same floor. There is trained nurse cover on each floor throughout the twenty-four hours. During the morning a team of ten carers is divided between the floors with eight on a late shift and four on a night. In Spillers the residential floor has a two carers on duty during the day and the nursing floor has a trained nurse supported by a carer. An ancillary team of domestic and laundry staff support the care teams. The home employs a maintenance person and an administrator. There are two cooks and two kitchen assistants to manage the meal production. Staff spoken with said staffing was sufficient to meet the residents’ needs with the exception of the cook who thought the kitchens needed another assistant to maintain the level of cleanliness required. The files for three new staff were inspected and two were found to contain all the checks for recruitment undertaken before the person commenced in post. One file did not have evidence that identification documents had been seen. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 20 In one file there was evidence that a gap in work history had been explored and the person had written and signed a declaration of the occupation during the relevant period. The records showed that the personal identification number (PIN) for one trained nurse had expired the previous month. The manager said that Four Seasons payroll had a system to alert when PINs were due to expire so they were surprised this had been missed. They immediately checked with the nurse who confirmed that their PIN had been renewed. The home currently employs fifty-two care staff of whom sixteen hold an NVQ qualification at level 2 or over. Seven staff are undertaking the programme. The staff training programme had lapsed in the past year but has now been recommenced and mandatory training has been planned for all staff over the next months. Some staff spoken with said they had had recent fire awareness and infection control training. Trained staff said input from a pharmacist had been accessed to help with improvement in medication administration practice and management of medicines. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 21 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, 36, 38. Quality in this outcome area is adequate. People who use this service can expect to be consulted and have their finances safely managed but cannot be assured that all health and safety practices will protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been without a permanent registered manager for over a year. A new manager with many years experience in managing care homes and with a nursing background has been in post for two months. CSCI await an application for this manager to be registered. The home has recently appointed a new deputy manager and a housekeeper manager, which is a new post but will give the ancillary staff direct line management. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 22 Residents spoken with said staff respond to requests and listen to them when they express views. Four ‘have your say’ comment cards received before this inspection all say staff listen to them and act on what they say. Relatives’ cards also said staff respond to requests. Minutes were seen of a recent relatives meeting where subjects such as staffing, activities, cleaning and the key worker system were all discussed. Previous inspections have looked at the system for managing residents’ personal monies and found it to be satisfactory. The manager and administrator confirmed that the system remained the same. The new manager has recommenced staff supervision and staff confirmed that they have had supervision sessions. They said they felt able to raise any issues and records seen showed that training needs and problem areas of care were discussed. During the tour of the home it was noted that a number of emergency call bell cords were tied up away from floor level in some toilets. In the kitchen the flooring was noted to be in poor condition with repairs and poor joins making it difficult to keep clean. Replacing this flooring had been a requirement after an environmental health inspection in May 2006 and again in December 2006. As noted earlier in this report a further visit was made the same week as this inspection and a telephone conversation with the officer confirmed that the conditions found in the kitchen were unacceptable. The staff team had made efforts since the visit to bring the cleanliness up to standard but the flooring remains an issue. Minutes of a health and safety meeting were seen and showed discussion was held about water temperatures, fire safety, control of substances hazardous to health (COSHH) training and moving and handling equipment. Additional slings have been purchased for use with the hoists. Records of water temperatures were seen and showed that water temperatures were being maintained around the recommended level. The maintenance person confirmed that a thermostatic control had been fitted to taps in Spillers that had been identified at the last inspection as being a risk. A service sheet for the hoists was seen and showed that most hoists were safe to use. Two had been marked as not fit for purpose. The deputy manager checked that they had been taken out of use and said they were waiting for new parts in the maintenance person’s workshop. A new routine of handover between senior staff has been established called ’10 at 10’. This handover would identify residents whose health needs had changed necessitating a move from residential to nursing care. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 23 It would also identify residents who need to move from Kingfisher to Spillers for dementia care. A protocol for reassessment of such residents needs to be developed to show why the move is being considered and care plans to reflect the changes in care and support required should be developed. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 24 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 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 1 Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 25 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 (1) (2) (b) 13 (2) Requirement Care plans must reflect the assessed needs of the residents to make sure they receive the care and support they require. Medication must be given according to the instructions on the MAR sheet to protect residents from harm. Steps must be taken to ensure that the menus offered supply adequate varied and wholesome nutritional content to maintain the interest and health of the residents. Furniture and carpets in the home must meet an acceptable standard to make sure that residents live in a pleasant environment. The décor in the bathrooms must be upgraded so residents can bathe in pleasant surroundings. Steps must be taken to ensure unpleasant odours are eradicated to make sure that residents live in pleasant surroundings. Steps must be taken to ensure the workforce has achieved suitable qualifications for the DS0000024427.V339375.R01.S.doc Timescale for action 04/05/07 2. OP9 04/05/07 3. OP15 16 (2) (i) 31/07/07 4. OP19 23 (2) (b) (c) 31/08/07 5. 6. OP21 OP26 23 (2) (b) 16 (2) (k) 31/08/07 04/05/07 7. OP28 18 (1) (a) 30/11/07 Kingfisher House Residential and Nursing Home Version 5.2 Page 26 8. OP29 19 (1) (b) (i) Sch 2. 9. OP30 18 (1) (c) (i) 10. OP38 17 (1) (a) Sch 3. 11. OP38 23 (5) 12. OP38 13 (4) (c) work they are doing to make sure residents receive the correct care. Copies of documents seen for identification of staff must be kept in the relevant files, available for inspection to show proof that recruitment procedures have been correctly followed to protect residents. The activities co-ordinator must receive training in working with people with dementia so they can offer a complete service to the residents in Spillers. Steps must be taken to develop a procedure for managing the transfer of residents within the service whose health needs change. This is to evidence that reassessment has taken place and residents are being supported according to their needs. Action must be taken to meet the requirements of the environmental health officer including replacement of the kitchen floor covering to protect the health of residents. This is a repeat requirement. Emergency call bell cords must not be tied up out of reach so residents can access them if they need to. 04/05/07 31/07/07 30/06/07 30/06/07 04/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations The training programme that has been re-instated should DS0000024427.V339375.R01.S.doc Version 5.2 Page 27 Kingfisher House Residential and Nursing Home be continued to make sure all staff are updated with mandatory training subjects ensuring that residents are supported by knowledgeable staff. Kingfisher House Residential and Nursing Home DS0000024427.V339375.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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.V339375.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!