Inspection on 07/12/05 for Kingfisher Nursing Home

This inspection was carried out on 7th December 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 04/08/05

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 Hertfordshire EN8 9NQ Lead Inspector Pat House Unannounced Inspection 7th December 2005 11:00 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 Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kingfisher Nursing Home Address Emmanuel Lodge College Road Cheshunt Hertfordshire EN8 9NQ 01992 627 939 01992 632708 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) Mr P S Patel Mrs Anjani Patel Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 4th August 2005 Date of last inspection 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 DS0000019574.V272109.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place during one day with one inspector. Since the previous inspection in August, an additional visit had been made to the home, in October, to check the progress of implementing the improvements, which were needed to raise standards in the home. A new Manager had been appointed in October and she was present during this inspection. Staff and service users were spoken with during the visit, all parts of the building were checked and records were examined. What the service does well: What has improved since the last inspection? The new Manager has worked hard to implement improvements in the home whilst maintaining the established procedures, which work well. Staff and residents said they felt the Manager was effective and staff felt supported and more optimistic about the management. In general, morale in the home appeared much improved. The refurbishment in the building was almost finished and there are now adequate bath and shower rooms and a new staff room in use. Recruitment procedures were also more thorough and regular staff meetings had been taking place. Most of the requirements made after the previous two visits have been addressed and The Manager is planning the changes, which will address the outstanding issues. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 6 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 DS0000019574.V272109.R01.S.doc Version 5.0 Page 7 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 Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 and 5. Standard 6 does not apply to this home. Prospective service users and relatives are able to visit and assess the home before admittance, to ensure its suitability and individuals receive a formal contract on entry so that all parties are clear about the terms of occupancy. The home’s policies make sure that the nursing and care needs of service users can be met. EVIDENCE: Standards 1 and 3 were assessed and met at the previous inspection. All service users are issued and sign a contract with the home. Some of these documents were checked during the visit and contained all appropriate information, including the actual room to be occupied in the home. The home provides nursing care and most service users have substantial physical needs, which the care and nursing staff are trained to provide. There is always a registered nurse on duty and individual service user records give thorough details of need and the care practice observed demonstrated that these physical needs were being met. There were two recent admissions listed in the home’s Admissions Book and in both cases there was evidence that families visited the home to assess its suitability before their relative took up a place. It was impractical for either service user to visit the home before moving in. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 and 11. Standard 8 was assessed and met at the previous inspection. Detailed and meaningful care plans ensure that staff in the home are aware of and can therefore meet the individual needs of service users. Policies and procedures in the home make sure that service users are supported, protected and treated appropriately at all times. EVIDENCE: As commented on at the previous inspection, the content of care plans and the standard of recording in these records is very high. All areas of individual need are covered in the records and those examined were signed by service users or families. There were good instructions about nutritional needs in the plans, and, in one case, instructions for giving “bonus” syringe feeds were seen being appropriately followed by care staff. It was noted in plans that only qualified nurses should give peg feeds and care staff confirmed this happened. There were appropriate risk assessments in place including those regarding the issue and use of keys, and individual property lists were in place and had been signed. There were also risk assessments completed for all residents regarding their ability to self-administer medication. Family members had signed that they were aware of the procedures for accessing records and service users had signed details of their wishes regarding death and dying. Records listed the use of appropriate aides including which sling was required for each individual use. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 10 The records also had a section for leisure activity preferences and overall they provide meaningful details about all service users. The room used to store medication has a locked drugs fridge and records were seen of temperature checks for the fridge and the room and showed that correct temperatures were being maintained. Most medication administered was provided in blister packs but some was stored in original packaging. All such packs are returned at the end of the month except for some paracetamol, which had the date of opening recorded. The home has a contract with a company who now dispose of unused medication and all returned medication is listed by the staff. Staff were reminded that all written instructions regarding medication should be signed by two staff members to ensure accuracy. Service users spoken with confirmed they always wear their own clothes and receive their mail unopened. They also said that staff members treat them with respect and always knock and wait before entering bedrooms and that they see doctors and health professionals in private, usually in their own rooms. One resident had been very ill recently and had chosen to die in the home. Staff said he had remained very peaceful throughout this period and that his doctor and family had been fully involved and supported by staff. During the visit, a letter of thanks was seen, sent by the family in question, expressing their gratitude for the care shown to their relative. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Standards 13 and 14 were assessed and met at a previous visit. Residents benefit from meals they enjoy in the home, but need to see daily menus. The current provision of activities is not adequate to satisfy or stimulate service users. EVIDENCE: Currently an activities co-ordinator works for two hours on two days of the week and for six hours on two other days. Some forthcoming activities were advertised on a wall in the home, but these were not extensive. Records were seen of what activities had taken place and these included bingo and simple exercises. However, details also showed that it was mainly the same five people who attended these sessions, with increased numbers taking part in the weekly outside entertainer’s events and the religious services. Service users and staff spoken with felt that not enough activities took place in the home and the Manager is aware of the need to provide more stimulation for the residents. Residents spoken with said they enjoyed the food in the home but none were sure what would be served that day. Staff spoken to also did not know what the meal would be. Residents are asked to choose their meal the day before it is served, but clearly forget their choices and it was recommended that daily menus are displayed in the dining room. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 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 the following standard(s): These standards have all been checked and met at previous inspections. EVIDENCE: These standards were not assessed on this occasion. No complaints about the home have been recorded by the home or received by the CSCI during this year. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 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 the following standard(s): 19,21,23,25 and 26. Standards 20,22 and 24 were checked and met Service users now benefit from living in an appropriate, pleasant and well maintained environment with sufficient bath or shower rooms to meet their needs. EVIDENCE: Most refurbishment of the home has now been completed and the home looked bright, clean and well maintained at this visit. There was a new bathroom in use and the staff now have a staff room with sink and good facilities. The decoration in the shower room was still being finished but the room still looked attractive and clean. Hot water was being delivered at safe temperatures, and was actually quite cold in some areas. Care staff said that the water temperature is regularly boosted during the day and that this would soon be done. Domestic and care staff confirmed that new linen, towels, quilts and general bed linen had been purchased for service users. These items were currently being labelled and would then be in use. Residents bedrooms all looked bright and clean and all meet the space requirements of the National Minimum Standards. There is emergency lighting provided in the home and radiators have low temperature surfaces and heat controls can be adjusted. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 14 The residents spoken to said the home is always warm enough. There is some CCTV cover around the outside of the building, but this is controlled and monitored by the Local Authority as part of Emmanuel Lodge. There were no unpleasant odours apparent in the home during the visit. All areas looked clean and service users said that standards of cleanliness in the home were good. The domestic worker and other staff members spoken to said there were always good supplies of disposable gloves, thicker gloves and aprons. The shower room did have a tablet of soap for use and no liquid soap, but staff said this was just a temporary measure and that liquid soap was used for infection control. The home has a contract with a local company for the disposal of clinical waste. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. The home’s current recruitment practices help to protect service users but a reassessment of staffing numbers and training is needed to ensure that the needs of residents can be safely met. EVIDENCE: During the morning of the visit there were five care workers on duty, as well as one registered nurse and the Manager. The individuals working were as listed on the staff rota, which was seen. The home does not have a deputy Manager and no laundry assistant has yet been appointed, although interviews are due to take place for this domestic position. Service users spoken with did not comment about staffing levels but care staff still felt there were not enough staff on duty at peak times, especially at night and at weekends. Also, because there is no laundry assistant, care staff are dealing with all the laundry tasks as well as providing breakfasts, teas and cleaning duties at the weekends. These domestic duties are shared, but the net result is to reduce the care staff numbers dealing with the residents, so that only four are available for care at the weekend. Most current service users require two carers to provide safe transfers and care and it would appear that more staff must indeed be needed to ensure that all needs can be safely met. Staff indicated that at peak times, when the nurse is dealing with medication, service user transfers using the hoist, sometimes take place with only one care worker, and do not follow the moving plan or training guidelines. The Manager said that an evening shift may be introduced to the home, with additional staff working between 6 and 11 p.m. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 16 The manager is also trying to increase the numbers of “Bank” workers who are available to work at short notice. Staff said that, currently, service users who require two care workers for transfers, are “ put to bed” at 6.30 p.m., before the night shift comes on duty. Although no service users expressed concerns about their bed times, this routine does not leave much room for individual choice. Staffing levels and staff deployment will be reassessed at the next inspection and the requirement for this area has been carried forward from the last inspection report. There had been a recent training course for all staff to update Moving and Handling skills, and staff spoken with had completed Health and Safety and Fire training. The Manager is currently producing a training overview, which will be checked at the next visit. Currently, four of the twelve care workers have completed NVQ 2 training and the Manager is aware that the national Minimum Standards suggest that at least 50 of care staff are trained to this level, and hopes to have more care staff undertake training soon. A selection of staff recruitment files were examined and all had appropriate references in place and staff had CRB/POVA clearance before they started work at the home. The Manager said that formal staff contracts are issued after the probation period has been completed. It was suggested that the staff application form for the home should be amended to provide more space for employment history, but in general current recruitment practices are thorough. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38. The management and general procedures in the home help to ensure that service users are protected, and that their interests are promoted and that practices protect and encourage staff in the home which also benefits service users overall. EVIDENCE: The new Manager for the home is a registered nurse and is currently studying for the NVQ 4 qualification. The Manager said that she will soon be applying to register with the CSCI. Staff and service users spoken with expressed confidence in the new Manage and said they found her supportive and approachable and felt their views were taken in to consideration. The Manager has already held several staff meetings and the minutes were seen. The topics covered were varied and appropriate. The domestic worker confirmed that she was included in these meetings. The Manager has started to implement a Quality Assurance system and said that the Proprietors were working on a business plan. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 18 Records were being kept securely and the certificate giving insurance cover for the home was on display. Staff in the home do not hold any service users’ money, or handle their finances. Financial matters are dealt with by families, advocates or social workers. A system for staff supervision is being set up and progress will be assessed at the next visit. The Manager said that service users could access their records at any time and evidence on care plans showed that families sign that they understand the procedures for access, which comply with the Data Protection Act. Servicing records for the home were up to date and staff and service users confirmed that fire alarm tests and fire drills take place. The records of drills were seen and listed the names of those attending and any issues arising. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 19 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 3 x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x 3 x 3 x 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 20 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 OP12 Regulation 16(2)(m) & (n) Requirement The Registered Provider must plan and fund an appropriate activities programme for service users. THE PREVIOUS TIMESCALE OF 01/12/05 HAS NOT BEEN MET AND THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS. The Registered Provider must ensure that at all times, enough care staff are on duty in the home to meet service users needs in a safe way. THE PREVIOUS TIMESCALE OF 01/12/05 HAS NOT BEEN MET AND THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS. Timescale for action 01/03/06 2 OP27 18(1)(a) 01/02/06 Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 21 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 OP15 Good Practice Recommendations The Registered Provider should ensure that daily menus are displayed in the home where service users can see them. Kingfisher Nursing Home DS0000019574.V272109.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire 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. 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