Inspection on 08/06/05 for Kingfisher Nursing Home

This inspection was carried out on 8th June 2005.

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.

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 04/08/05

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: 10:00 8 June 2005 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 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kingfisher Nursing Home Address Emmanuel Lodge College Road Cheshunt EN8 9NQ 01992 627 939 01992 632 708 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 Patricia Davis Care home with nursing 22 Category(ies) of OP Old Age - 22 registration, with number of places Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate 22 older people in need of general nursing care. This home may accommodate 22 older people in need of convalescent care (aged above 55 years). Date of last inspection 12 October 2004 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 wheelcahairs 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 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one working day with two inspectors. The Manager was present for the inspection. Service users, staff and a relative spoke to the inspectors. The home has failed to comply with deadlines set for previous requirements to be actioned and so Enforcement Notices have now been served on the Registered Provider. A large number of additional requirements have also been made in this inspection report. 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 kingfisher v231107 080605 stage 4.doc Version 1.30 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 kingfisher v231107 080605 stage 4.doc Version 1.30 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 & 3. Standard 6 does not apply to this home. The home provides prospective service users with appropriate detailed information and individuals have full assessments completed, to ensure that all care needs can be met. EVIDENCE: The home has an up to date Statement of Purpose and Service User’s Guide, which are made available to all new service users and families. All prospective service users have full assessments completed. Evidence was seen on records of appropriate detailed information about service users and care summaries were in place for those referred from other agencies. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 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. Service user records detail all care and social needs and evidence that these needs are being met. Procedures for the administration of medication ensure that service users are protected and their health promoted. EVIDENCE: Service users’ care plans were checked and were very well documented. Those examined contained full details of individual needs together with records of the individual monitoring expected with nursing care. There were meaningful risk assessments in place including those for equipment and recliner chairs. Falls were risk assessed and were being regularly reviewed and there were risk assessments for service users’ use of keys. Records contained signed evidence that service users were aware of their right to see and be involved in their care planning. Property lists were signed by service users or relatives and general monthly reviews were documented. There were also “Quality of Life” surveys, including social preferences, signed by the resident and family. Currently two residents have pressure sores and their treatment and progress was recorded. Residents’ weight was being regularly recorded and monitored. Service users confirmed that they saw doctors, nurses, chiropodists and opticians, as recorded on files. Some service users said they had had regular help from a physiotherapist, until about a year ago, and that they now felt they needed this help again. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 9 The Manager said staff would reassess service users with the G.P. and would refer any one to the physiotherapist if appropriate. Only the registered nurses in the home give out medication. Procedures were checked and were all properly documented, with no gaps on the record charts. Appropriate codes were being used where medication was not administered and details of admittance and return addresses were recorded in a controlled drugs book. Supplies of drugs checked tallied with amounts recorded. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 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, 13, 14 and 15. Service users do not generally find the activities in the home are stimulating or adequate. Contact with family and friend is encouraged and residents are supported to make choices and keep control of their own lives as much as possible. The home provides appropriate meals, which are enjoyed by service users. EVIDENCE: All service users have a written leisure plan and the activities co-ordinator records details of which activities residents take part in. Regular Church services take place in the home and one was in progress during the inspection. A hairdresser visits the home on alternate weeks. The home has no transport of its own but the Manager said a new transport scheme had been set up in the area, which should now enable staff to take some service users out. The activities co-ordinator has some of her contracted time allocated to care working, but provides regular weekly bingo and quiz sessions at the home. There is no budget in the home for activities and staff said that some of the games and equipment was obtained from a charity shop and the library had provided free “memory therapy” packs which staff use with residents. Service users said they enjoyed what activities there were and the bingo sessions were very popular. Residents currently pay £1 each per week so that prizes can be purchased for bingo and raffles. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 11 Residents spoken to felt there could be more activities in the home and a recent Quality Assurance survey showed this was felt generally. Staff were aware that courses are available for planning activities for those in wheelchairs and felt this would be an appropriate training provision for the home. A more structured and varied programme of activities clearly needs to be funded and developed in the home. Visitors to the home, spoken to during the inspection, said they were made welcome at all times and could see their relative in private if they wished. Residents have had a visit from Age Concern and were told about advocacy services. Leaflets were also displayed around the home. Residents confirmed they were able to bring some of their own possessions with them to Kingfisher and most bedrooms had been personalised with service users’ belongings. Service users were seen eating the mid-day meal and all said they enjoyed the food in the home. Tables in the dining room were well laid out and all had napkins and condiments. Service users were offered gravy with the meal and all had drinks. Residents were assisted where appropriate and the meal was unhurried. Residents said that an alternative choice was offered for the main meal or salads were available. At the end of the meal, residents were offered “wet-wipes” to use. The kitchen is shared with staff of Emmanuel Lodge, but kitchen staff said this presented no problems. The cook currently provides special meals for diet controlled diabetics and said the evening meal was a hot meal or sandwich tea, alternating on every other day. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 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, 17 and 18. The home’s policies and procedures ensure that complaints are dealt with appropriately and that service users are protected from abuse. EVIDENCE: The home has a written complaints policy, which has been updated with current CSCI details. There is a complaints book, which was left in the reception area for anyone to write in. Those issues written in this book had all been dealt with. This book was discussed with the Manager, as it was felt that recording in such an open way did not comply with the Data Protection Act and might discourage some people from entering concerns, as there was no privacy. However it was acknowledged that the procedure was there to ensure an open approach was taken to complaints. The Manager will now leave blank complaints forms in the reception area, for anyone to complete, but will keep completed forms in the office. Residents spoken to confirmed they would tell staff if they had any concerns in the home. They also said they had been given the chance to vote in the last election. The home has written policies on Adult Abuse and Whistle blowing, which staff were aware of. Procedures for dealing with service users’ money will be checked at the next inspection. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 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, 20, 21, 22 and 24. Enough accessible communal areas in the home help to provide a comfortable environment for service users but insufficient washing facilities and adaptations to bathrooms mean that all residents’ needs cannot be adequately met. EVIDENCE: There are adequate communal areas in the home for residents and furnishings are generally of good quality. There are also enough toilets available to service users and these have been fitted with aids and adaptations. However the home has continually failed to meet the environmental requirements made after previous inspections and only two of the four bathrooms in the home are available for use. There is no shower facility available and no en-suite facilities in the home. Generally the bathrooms are in a poor state of repair. In addition, none of the bathrooms are assisted and facilities therefore do not meet the needs of a 22 bedded nursing home. All bedrooms are adequately furnished and carpeted and most service users have their own possessions around them. However, not all rooms have lockable storage and requirements to provide this have been made at the previous two inspections. A time scale of four months was set at the previous inspection for these issues to be dealt with. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 14 This time scale has not been complied with and no written explanation has been given to the CSCI. The flooring in the dining room is also very stained and needs replacing. Generally bedding is also inadequate. New bed linen has been provided, but only one set for each bed, and towels and blankets should also now be replaced. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 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 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. Numbers of staff on duty in the home are not adequate to meet all service user needs and recruitment procedures are not adequate to ensure service user safety. EVIDENCE: Service users said that the home was sometimes short staffed and care staff also felt that the numbers on duty were insufficient to ensure that all residents’ needs could be safely met. The Manager said there was always a qualified nurse on duty and that on most mornings there were five care staff, two staff in the kitchen and one domestic on duty. In the afternoons three care staff are on the rota as well as the nurse. However at least one bath is scheduled every afternoon and care staff also have to take turns in the laundry. At weekends, care staff also have to provide domestic services and prepare breakfasts. At night there is one nurse and one care worker on duty. Staff said that no agency staff are ever employed, so that times of staff sickness are always difficult. The home’s deputy manager left at Christmas and has not been replaced. Staff said that inevitably, with these care worker numbers and only five of the current service users not requiring two care workers for assistance, some unsafe practice does take place. At lunch time, care workers were seen moving residents up in wheelchairs manually and staff said the hoist is often used by only one care worker. Staff felt that some of these practices did not follow Moving and Handling guidelines for good practice, as there were insufficient staff numbers to provide assistance in any other way. The Manager has now resigned from her post and four care workers have also resigned in the last two weeks. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 16 It is believed that present staffing numbers are not adequate to safely run this nursing home and that the position of deputy is also essential to the satisfactory running of the home. Recruitment files were checked, for the newer staff. Not all contained two written references, and not all references included a previous employer. The current application form does not allow enough space for a full employment history to be declared and does not indicate that the dates of previous employment should be shown. Recruitment procedures and records need to be improved to ensure service user safety in the home. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 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 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. Current management arrangements in the home do not provide a sound structure or ensure continuity of care for service users. Some health and safety procedures must be reviewed so that the welfare of service users and staff are protected. EVIDENCE: As already stated, the current registered manager has resigned from her post. The CSCI had not been informed of the situation, prior to the inspection, although the manager leaves at the end of July. The Manager is not aware that arrangements have been made for replacing her when she goes. It is felt, and also indicated by staff, that not replacing the deputy manager in the home has been detrimental to the day-to-day running of Kingfisher. Staff also said that during the Manager’s recent holiday, management cover had been provided by staff in whom care workers had little confidence. The Registered Manager is also responsible for providing a number of regulated services for the benefit of service users and would seem unable to fulfil these responsibilities without a budget to fund them. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 18 The home has written policies covering safety at work and has general risk assessments for the home. Fire equipment is regularly serviced but the Manager explained that fire drills are difficult to arrange as the alarm system is shared with Emmanuel Lodge. The manager will negotiate some joint arrangements for holding drills and will review written fire procedures. As already described, some procedures for moving and handling service users may need reviewing and there must be enough staff working to ensure everyone’s safety. The CSCI receives notification of serious incidents and accidents in the home, but it has not received monthly Provider’s reports since February as is required by Section 26 of the Care Standards Regulations. Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 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 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 3 1 2 x 2 x x STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x x x x x x 2 Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 20 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) 23(2)(b) Requirement The Registered Provider must plan and fund an appropriate activities programme for service users. The Registered Provider must keep the premises in a good state of repair, must produce a timed action plan and comply with agreed timescales. The Registered Provider must ensure that the four bathrooms in the home are redecorated and refurbished and are in working order. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT ACTION HAS NOW BEEN TAKEN. The Registered Provider must provide appropriate assisted baths and showers for service users in the home. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT ACTION HAS NOW BEEN TAKEN. The Registered Provider must provide lockable storage facilities in bedrooms of service users. Timescale for action 31st August 2005 1st August 2005 2. 19 3. 21 23(2)(j) 31st August 2005 4. 22 23(2)(n) 31st August 2005 5. 24 23(2)(m) 1st August 2005 Page 21 Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 6. 27 18(1)(a) 7. 29 19(1)(b)& Schedule 2(1) 8. 31 39(b) 9. 38 13(5) 10. 38 23(4)(d) &(e) 23(3)(a) 11. 19 12. 38 26 THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT ACTION HAS NOW BEEN TAKEN. 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 Registered Provider must obtain and keep all the required staff information, including two appropriate references and full emploment histories. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT ACTION HAS NOW BEEN TAKEN. The Registered Provider must inform the CSCI in writing of proposed changes to the arrangements regarding the Registered Manager of the home. The Registered Provider must make safe arrangements for the moving and handling of service users. The Registered Provider must make arrangements for regular fire drills to take place in the building. The Registered Provider must provide suitable facilities for staff, including adequate provision for changing and taking breaks. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM PREVIOUS INSPECTION REPORTS AND ENFORCEMENT ACTION HAS NOW BEEN TAKEN. The Registered Provider must ensure that monthly inspections take place and that reports are forwarded to the CSCI. THIS REQUIREMENT HAS BEEN 1st August 2005 8th June and henceforth 1st August 2005 1st August 2005 1st August 2005 1st August 2005 1st August 2005 Kingfisher Nursing Home I52 s19574 kingfisher v231107 080605 stage 4.doc Version 1.30 Page 22 13. 24 16(2)(c) CARRIED FORWARD FROM THE LAST INSPECTION REPORT. . The Registered Provider must 31st August replace worn towels blankets and 2005 bed linen in the home. 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. 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