Inspection on 04/08/05 for Kingfisher Nursing Home

This inspection was carried out on 4th August 2005.

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

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

Other inspections for this house

Kingfisher Nursing Home 24/04/07

Kingfisher Nursing Home 04/05/06

Kingfisher Nursing Home 07/12/05

Kingfisher Nursing Home 08/06/05

Kingfisher Nursing Home 12/10/04

Kingfisher Nursing Home 20/04/04

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

CARE HOMES FOR OLDER PEOPLE Kingfisher Nursing Home Emmanuel Lodge College Road Cheshunt EN8 9NQ Lead Inspector Pat House Unannounced 4 August 2005 10:00 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 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 Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kingfisher Nursing Home Address Emmanuel Lodge College Road Cheshunt Hertfordshire EN8 9NQ 01992 627939 01992 632708 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr P S Patel Care Home with Nursing 22 Category(ies) of OP Old Age - 22 registration, with number of places Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate 22 older people in need of convalescent care (aged above 55 years). This home may accommodate 22 older people in need of general nursing care. Date of last inspection 8 June 2005 Brief Description of the Service: Kingfisher is a care home providing nursing and convalescent care for 22 older people. The home is situated on the ground floor of Emmanuel Lodge, a two storey complex which provides supported housing for older people. Emmanuel Lodge is owned by Broxbourne Borough Council and a Primary Care Trust. Currently Kingfisher Nursing Home is leased from these owners. The home has eighteen single and two double bedrooms. None of the bedrooms have en-suite facilities. There is level access suitable for wheelchairs throughout the home and lounge and conservatory areas for the benefit of service users. The home has its own laundry but kitchen facilities are shared with Emmanuel Lodge. Service users have access to the gardens and patio belonging to Emmanuel Lodge and there are extensive areas for parking around the home. The building is situated in an area of parkland on the outskirts of Cheshunt where there are shops, pubs and bus services. The A 10 trunk road, the M 25 motorway and rail links are nearby. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day with two inspectors. The previous inspection had taken place in June and from this requirements had been made, especially about the upgrade needed to the facilities, and enforcement action has been taken. An action plan has since been received by the CSCI with time scales for improvements to be completed. The Proprietors have now signed a contract for the lease of the building and will now ensure that work is completed in the home. The inspection was made to check that previous requirements have been implemented at the home and to ensure that appropriate management arrangements are in place as the registered manager has now left. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 7 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 standard(s) 1 and 3 at the previous inspection and these standards were met. Standards 1 to 5 were not assessed on this occasion. Standard 6 does not apply to this home. EVIDENCE: Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 8 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 standard(s) 7, 8 and 9. Care planning for service users is good and helps to ensure that all care needs are identified. However current staffing issues appear to be resulting in some care needs not being met. Procedures for the administration of medication are thorough and promote the well being of service users. EVIDENCE: Care plans and service user records were thoroughly checked at the last inspection and were very well maintained. Those checked on this occasion were equally thorough and meaningful, with appropriate risk assessments in place. However, one or two residents said that their personal care had been rushed lately and one service user said that care staff try to give her a strip wash weekly but “cannot always manage this.” One resident said her hair had not been washed for four weeks, and staff explained that the hairdresser had been unable to visit as usual and there were not enough care staff to wash everyone’s hair. One resident appeared to need her teeth cleaning and another resident, who was sitting in her chair in her bedroom, had a call alarm, which was out of her reach. Although residents praised the care staff, there was a general perception that not enough staff were on duty at peak times to ensure that care needs could be met. This view was discussed with the proprietor and will be reviewed at further inspections. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 9 Medication was seen being administered and procedures and recording were appropriate and thorough, as at the previous inspection. Staff were however reminded to keep the medication room locked when no one was in it, as it was left unlocked and unattended at the beginning of the visit. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 10 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 standard(s) 12 and 15. Standards 13 and 14 were assessed and met at the last inspection. The provision of activities in the home is currently not adequate to satisfy and stimulate service users. There are however, plans underway to improve this situation. Service users enjoy and benefit from the meals provided in the home. EVIDENCE: The activities co-ordinator had left since the last inspection and service users said that they had had little to do recently. There was a notice displayed about activities for August, which only listed the hairdresser, one religious service, a regular weekly organ session and said that some volunteer visitors would visit at some time. At the beginning of the visit service users were sitting in a lounge with the television tuned on to children’s programmes, which seemed quite inappropriate. However, a new member of staff has now been appointed whose duties will include planning activities and so this area will be reviewed at the next inspection therefore the requirement for improvements will be carried forward from the last report. As at the last inspection, service users said they enjoyed the food in the home. The mid-day meal was well presented and looked appetising. It was suggested that the day’s menu should be displayed for the residents to see and this should show what the alternative was if a service user did not want the main meal. One care worker was, however, feeding two residents at once, which was not very dignified for the service users. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 11 Some meals were also left for periods of between five and ten minutes, on the tables, before staff were free to assist with feeding and food was becoming cold by this time. This situation again suggests that there are not enough staff on duty in the home at all times of the day. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 12 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 standard(s) 16. All standards were also checked and met at the last inspection. The home’s policies and procedures ensure that complaints are dealt with appropriately and that anyone making a complaint feels comfortable doing so. EVIDENCE: The home has a written complaints policy which service users and visitors are aware of. Since the last inspection the complaints book has been changed to a folder with separate sheets, which can be used by anyone to complain without anyone else seeing what has been written. Procedures for dealing with service users’ finances will be checked at the next inspection. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 13 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 standard(s) 19, 21, 22 and 24. Standard 20 was assessed and met at the last inspection. Currently there are insufficient and inadequate bathing facilities in the home to meet the needs of residents and some furnishings need replacing to ensure service users’ comfort. EVIDENCE: Since the last inspection, the home’s Proprietors have submitted an action plan, with time scales, for improvements to be made to the home. A full action plan for repairs and maintenance is being produced, three bathrooms are to be refurbished, a new staff room will be created and assisted bathrooms and showers will be provided for service users along with the provision of lockable bedside cupboards. The Proprietors have given a time scale to the CSCI, which shows that improvements will be completed by 30th September. A further inspection will be made to re-assess the situation and the requirements for these changes will be carried forward from the last report. The Proprietor said that towels, bedding and carpets are also being replaced throughout the home. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. It still appears that numbers of staff on duty are not adequate to meet all service user needs but recruitment procedures are being improved to ensure service user safety. EVIDENCE: Most service users and care staff spoken to felt that there were insufficient numbers of staff on duty in the home to ensure that all care and domestic needs are fulfilled. There are 5 care workers on duty in the morning, 3 in the afternoon and 1 at night. In addition a registered nurse is on duty at all times and the proprietor is now managing the home. The home is currently without a deputy manager but has just recruited a new care worker who will provide activities as part of her role. In addition to providing care, care staff have to provide laundry services, provide breakfast and supper and help with activities. As already stated some residents feel their care needs are not being adequately met and one service user said they sometimes have to wait to go to the toilet as staff are busy elsewhere. Most residents need assistance to stand or transfer and most assistance should be with two carers, which inevitably uses high numbers of staff. As already stated, many of the residents also need assistance with feeding, including some who are fed in their rooms, and some have to wait for this. Several of the residents suggested that staff in the home appeared stressed and one said some have been arguing amongst themselves. It is inevitable that there has been disruption in the home as the manager has left so recently and it may be that the staffing situation will resolve itself as new care workers are employed. However, the requirement that enough staff are on duty at all times will be carried forward from the last report and will be assessed at the next inspection. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 15 Recruitment files were checked for the newer staff and references and CRB or POVA clearance was in place. Some files did not have a signed contract or staff photograph, but the proprietor said that recruitment files were now being updated gradually. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38. The home is currently being managed by the proprietor who is able to ensure that the home is run appropriately and for the benefit of service users. Improvements to procedures in the home are being made to ensure that the welfare of residents is promoted. EVIDENCE: Although a new manager had been appointed to the home, this person has been unable to take up the post and the post has been advertised again. The proprietor is managing the home in the interim. There has, as yet been no decision made to appoint a deputy manager for the home. Fire drills have taken place since the last inspection and monthly provider’s reports have been received by the CSCI. It was recommended that some freestanding fans in the home should be risk assessed and that a “standing hoist” might benefit the service users and care staff in the home. The proprietor was again reminded that there must be enough staff on duty to ensure that safe handling techniques are used in the home, for the protection of both staff and service users. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 17 The proprietor was also reminded that fire doors must not be wedged open and that if service users wanted the door near the reception area left open, an appropriate device must be fitted. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 1 x 1 2 x 2 x x STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x x x 3 Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? 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 12 Regulation 16(2)(m) &(n) Requirement The Registered Provider must plan and fund an appropriate activities programme for service users. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT. The Registered Provider must implement the action plan for refurbishment and decoration in the home within the agreed timescale. The Registered Provider must ensure that the bathrooms in the home are refurbished and in working order within the agreed time scale. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT ACTION HAS BEEN TAKEN. The Registered Provider must provide appropriate assisted baths and showers for service users in the home within the agreed timescale. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT Timescale for action 1ST October 2005 2. 19 23(2)(b) 30th September 2005. 30th september 2005. 3. 21 23(2)(j) 4. 22 23(2)(n) 30th September 2005 Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 20 ACTION HAS BEEN TAKEN. 5. 24 23(2)(m) The Registered Provider must provide lockable storage facilities in the bedrooms of service users within the agreed timescale. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT ACTION HAS BEEN TAKEN. The Registered Provider must ensure that at all times, enough staff are on duty in the home to meet service users needs in a safe way. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM THE LAST INSPECTION REPORT. The Registered Provider must provide suitable facilities for staff, including adequate provision for changing and taking breaks. THIS REQUIREMENT HAS BEEN CARRIED FORWARDVFROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT ACTION HAS BEEN TAKEN. The Registered Provider must replace worn towels, blankets and bedlinen in the home. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT. 31ST August 2005. 6. 27 18(1)(a) 1ST OCTOBER 2005. 7. 19 23(2)(a) 30TH September 2005 8. 24 16(2)(c) 31st August 2005. 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 Good Practice Recommendations There are none. Kingfisher Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 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 Nursing Home I52 s19574 3 kingfisher v245709 040805 stage 4.doc Version 1.40 Page 22 - 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. 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