Inspection on 05/07/07 for Kingfishers Nursing Home

This inspection was carried out on 5th July 2007.

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

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

Other inspections for this house

Kingfishers Nursing Home 07/08/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Kingfishers Nursing Home Fieldhead Gardens Bourne End Buckinghamshire SL8 5RA Lead Inspector Kerry Kingston Unannounced Inspection 5th July 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 Kingfishers Nursing Home DS0000066749.V344864.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. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingfishers Nursing Home Address Fieldhead Gardens Bourne End Buckinghamshire SL8 5RA 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) 01628 520020 01628 524973 kingfisherscare@aol.com Kingfisher Carehome Limited Mrs Shelley Ackland-Snow Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: Kingfishers is a privately owned care home providing personal and nursing care to 43 older people. The home is situated in Bourne End, close to the shops and amenities of a small town. Marlow and the river Thames are a short drive away. The building dates back to 1904 and has been sympathetically restored and adapted for its current use. There are 25 single rooms and nine shared rooms. Many of the rooms have ensuite facilities. Access to the upper floors is via a passenger lift. The gardens are well maintained, attractive and easily accessible to older people. Fees range from £650 to £850 per week. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a report for the key inspection, which included a routine unannounced site visit. This took place between the hours of 10.00am and 8.00pm on the 5th of July 2007. The information was collected from an Annual Quality Assurance Assessment, a document sent to the home from the Commission for Social Care Inspection and completed by the manager, surveys which were sent to people who use the service, other professionals and families of residents. Seven surveys from residents and nine surveys, which were completed by families, were received in response. Discussions with three staff members, the registered manager, the training manager and six people who use the service took place. There was further communication with and observation of other people and staff during the course of the visit. A tour of the home and reviewing residents and other records was also used to collect information on the day of the visit. What the service does well: The home looks carefully at peoples’ needs so that it can be sure that they can meet those needs. The staff team treat people with respect and dignity so that they can retain their privacy and continue to feel that they are valued. The home tries to make sure that there are activities that people like to participate in so that they do not get bored and continue to enjoy life, as far as possible. The home makes sure that people get a good choice of food and it is served in the way that meets their needs and that people enjoy their meals. The home makes sure that it listens to the people who live there and it acts on those views and opinions, when possible. The home is well kept , clean and hygienic and has a programme of redecoration to make sure the home remains pleasant to live in. The home is well managed and has a well - trained and stable staff team that can look after the residents properly. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 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 Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable) The people who use the service experience good quality outcomes in this area. The home provides prospective residents with a Statement of Terms and Conditions that they are asked to sign prior to admission. The prospective residents have their needs thoroughly assessed and the homes care plans demonstrate that they are able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assessments for the two newest residents were looked at, both contained basic assessments, (the pre-admission assessment is completed by the homes’ manager) and care management assessments. One Care Plan had been completed from the basic assessment and the other was being developed from a full needs assessment. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 9 People and/or their families are invited to visit the home, where possible. Many residents are admitted from a hospital setting and are unable to visit the home prior to admission but a review is held after approximately eight weeks to look at the appropriateness of the placement. Notes are not always kept of these meetings, and they are not always held for those people who privately fund their care. The manager said that this is an area that is being developed and the plan is to make sure everyone’s’ care is reviewed after eight weeks, which has been identified as a trial period. During the inspection visit two people arrived for a look around the home to see if it was suitable for a relative, they were shown around the home including the particular room that was vacant. Six of nine surveys received from families noted that ‘people always or usually have enough information to make a choice’ One of the eight said ‘they do not receive enough information to make a choice’. All seven surveys received from people who use the service said people usually have enough information to make a choice, some surveys noted that their families had made the decision for them. People have statements of terms and conditions sent to them prior to admission and sign and return or bring on admission. One person noted that conditions changed with a change of ownership and at that time people did not have any choice but to accept that they had to pay for additional things such as hairdressing, chiropody and newspapers. The manager confirmed that the home does not offer intermediate care, occasionally respite if beds available. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 10 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 and 11. The people who use the service experience good quality outcomes in this area. The home meets the health, personal and social care needs of the residents, by developing good quality care plans and responding to their changing needs, as appropriate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six of the people who use the services care plans were seen, they include personal hygiene, maintaining a safe environment, mobility, elimination, communication, nutrition, sleep and rest, psychological, social, sexual, cultural and religious needs, activities and special or ‘specific’ needs such as pressure sores or nutritional issues. Care plans are reviewed monthly and changes made as necessary, changes or deterioration of conditions could be more clearly recorded. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 11 All personal and social care needs are set out in individual plans, a new format for these has been developed during the past year. Diversity and equality issues are addressed in individual care plans, these include religion and culture and any health or sensory diversities. Six of the nine surveys received from families noted that the home gave ‘very good care’ One of eight said there is a ‘15-20minute’ wait for call bells to be answered. Four of six people spoken to said that they ‘usually’ did not have to wait long after ringing their bell, one person said that she ‘sometimes’ had a long wait and someone once turned her bell off and went away. One of seven surveys, completed by the people who use the service, noted that waiting for call bells to be answered was an issue , the other six said that staff were usually around when needed. Healthcare needs are set out in a nursing plan, these include manual handling risk assessments, a care dependency assessment, a risk of developing pressure areas assessment, a nutrition assessment, weight charts, blood sugar records, a treatment sheet and fluid balance records. Daily health records are also kept, for individuals, they are kept in treatment rooms with the medication. The treatment of pressure sores is noted, where applicable but it is not clear what is done with regard to the prevention of pressure areas. On some care plans prevention methods are clear such as special mattress, washing routine and changing position routine. One person, in the home has a pressure area, currently, it is not clear what was done to prevent the pressure area developing but the treatments and dressings are clear and well recorded. Some daily notes clearly reflect that the care given matches the care plans but some are not so clear. This issue was discussed with manager who noted that recording is part of the ongoing training of staff and this area of work is being addressed. A Dr. visits the home weekly for a routine visit and sees those people who have ongoing health issues or request a visit. The Doctor is called in, if necessary, at any other time. Nutritional risk assessments and weight records are kept where necessary. The chef is aware of the nutritional needs of all the residents and the kitchen lists are up-dated daily with regard to how food should be served, large or small helpings and food supplements. Continence needs are noted on care plans and the Annual Quality Assurance Assessment noted ‘ changes in toileting routines making it more efficient’. This mainly refers to the lunchtime period when everyone wants to use the toilet before settling down for the afternoon. There is a limited amount of toilets and staff as many residents need two people to help them. Three of the six people spoken to said that they ‘sometimes had to wait for staff when they wanted to go to the toilet, mainly at lunch times’. There were some comments received from families, about the home not being able to deal as well with people as their health deteriorated and not helping people to retain mobility. The home recognises mobility as an issue and it is Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 12 noted that many residents choose to be less mobile because of frailty and pain. One very elderly resident has been helped back to some mobility after a broken ankle, the home worked closely with the community physiotherapist and they are now able to walk with a frame. Dehydration was noted as a problem on a complaint which was thoroughly investigated, ways to ensure people drink enough has been improved including fresh water dispensers on each floor Staff were seen taking water and drinks to people, throughout the day. The residents were observed to be wearing their spectacles, hearing aids and teeth on the day of the visit. Visits to opticians, dentists and audiology are noted on health care records. The Manager discussed the difficulties of getting community dentists and opticians but they seek the help of the G.P as necessary. The home has a good relationship with the surgery. There was a discussion about non- resuscitation directives, seen on peoples’ files, the manager agreed to discuss the legal issues with the providers and the Doctor to clarify what the homes policy will be and whether to remove the non- resuscitation notes. Medication is kept on three floors in locked rooms called ‘treatment’ rooms. A Monitored dosage system is used (Lloyds NOMAD system) by the home. Medication is delivered, mainly, weekly to minimise the amount of medication on the premises. Some ‘loose’ or bottled medication is delivered monthly. The home works closely with the local surgery and pharmacy to ensure an effective and safe medication administration system is operational. The pharmacist visits approximately three monthly to look at medication administration procedures and at the last visit had no concerns (as advised by manager). The home uses controlled drugs, mainly for pain relief and these are properly stored and administered. Administration Records seen, on the ground floor, were accurate and there were no missing signatures, medication is administered by registered nurses only. Three residents confirmed that they get medical help when they need it. The G.P visits and advice and treatment recommendations are recorded on individuals’ notes in the home, but official medical notes are held in the surgery. The seven surveys, completed by residents noted that they always or usually get the health care they need. The six people spoken to say that they are ‘good’ staff and that they are treated with respect. Staff were observed interacting positively with people, six of the nine surveys from families said that staff ‘give good care’, ‘they are caring staff’ , ‘staff are friendly and welcoming’, ‘kind courteous and helpful’. Staff spoken to clearly described ways of ensuring privacy and dignity including ‘you have to be extra careful in shared rooms and ensure the proper use of the screens’. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 13 One complaint and one survey said that the home ‘didn’t offer good palliative care.’ The manager described some ways they try to help people who are coming to the end of their life such as, making arrangements for family to stay with their relative, keeping families informed of peoples’ condition at all times, trying to move the ‘well’ person in a shared room to afford extra privacy to the dying person and their family and, under the Doctors’ direction, keeping people as pain free as possible. Residents are supported to attend their friend’s funerals and the home always sends a representative. The home will allow families to hold the wake in the home if it is appropriate, a wake was being organised on the day of the visit. The home has had 29 deaths since the last inspection, in August 2006, six of these have been in the last two months. The manager advised that she and the proprietor are aware of the seemingly high numbers and had looked closely at the circumstances. She advised that people being admitted are frailer than before, most come straight from hospital who discharge them earlier and some people have been in the home for some time. The manager was advised to include the Cause of death on the regulation 37 notifications even if this means they are delayed for a day or two, the manager agreed to put this into effect immediately. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15. The people who use the service experience good quality outcomes in this area. The home makes sure that residents have an interesting daily life, with access to activities if they choose. Staff help them to make choices, wherever possible. The home offers good quality and varied food and makes sure that people with special nutritional needs have the help that they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities co-ordinator, employed for ten hours per week, two days per week. A music man visits twice a week, a church group once a week, a Methodist minister once a month, a Church of England minister once a month, a 7th day Adventist group on a Sunday, manicures once a week, bingo and quizzes and occasional entertainers. Residents get involved in some baking every eight weeks and have a chocolate fountain for special occasions. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 15 Individuals are also taken out by family members or the activities co-ordinator, who also does 1:1 work and reminiscence work. People are occasionally taken to the local garden centre or to community activities, as available and possible (such as pantomime and late night shopping). The home organises social occasions approximately four times a year, the annual summer garden party was being organised on the day of the visit. Residents have televisions, radios, talking books, knitting and other of their preferred pastimes in their rooms. Six people said that they have enough to do and choose what they want to do. Some chose not to leave their rooms as they preferred to watch the television and knit, another prefers watching sport and talking to people. One person said that if staff were sick or on holidays activities were sometimes cancelled. The seven resident surveys received said that activities were usually or sometimes available to them. Staff felt that people had enough activities and that they had time to talk to them and help them join in activities. Residents make good use of the garden, which is very attractive and well kept, weather permitting. The activity coordinator develops individual activity plans, these were not available on the day of the visit, the manager confirmed that people had activity plans as appropriate to their needs and wishes. Families and friends were seen in the home on the day of the visit and the visitors book showed an average of eight visitors (mainly families and friends) a day, over the period of a week. Staff were seen interacting with families and making time to talk to them and make them feel welcome. One visitor seen arriving at eight in the evening, staff confirmed that there were no restrictions on visiting times. Families were observed helping relatives with their meals and relating very positively with staff. Several visitors were seen in residents private rooms and taking people out for a walk. The home will often host the ‘wake’ for families if their relative has died in the home. The home has a residents’ forum held approximately every eight to ten weeks , notes are taken and an action plan is made by the manager of anything that she can change, do as a result of the views put forward by the residents. The notes of the meeting and the action plan are displayed in the home. The activity co-ordinator helps residents to complete annual questionnaires or will bring any issues that have been identified in their 1: 1 sessions to the manager. The last two residents forum meetings were seen to be well attended. The manager outlined several changes made as a result of opinions expressed at the forum for example, change to toileting routine after lunch, menu changes, a large clock put in the library, more notice boards and notices displayed and upright chairs (15 are in the process of being ordered). Three people said that they choose what to wear what time to go to bed and get up One person said that she has to turn her television off at ten although she would like to watch it later, she confirmed that she had not mentioned this to staff but she would do so. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 16 Staff members described how they make sure people are offered day –to- day choices such as clothing and food and what they want to do and where they want to sit. One resident noted in the survey that they were not ‘helped to choose what they wanted to wear.’ Menus seen were varied and interesting, they reflected the culture of the resident group and had been amended after opinions expressed in the residents’ forum. Traditional British food was the residents favourite, some people are vegetarian, some have soft food, some have pureed food and some have liquid food, one person is tube fed by nursing staff. Diversity and choice are respected for instance one lady was asking for more ‘spicy’ food and this is to be provided for her, individually. People had nutritional assessments and individual needs are known to the chef and amended on a daily basis, as necessary. The dining room layout has been changed to give staff and residents better access, this means that more wheelchair bound residents can eat in the main dining room. There are three small tables for those people who do not have physical disabilities. These changes are discussed in residents forums and five residents spoken to said that they were happy with the table arrangement in the dining room, one resident did not like the arrangement but she does not leave her room and the friends she used to share the table with are either deceased or ‘not the same’. Those people who need help with eating were observed for a short while at the end of meals, they had eaten the food offered and a cheesecake was presented as a very attractive soft food that most people could eat. Family members were observed to be helping with feeding their relatives and there was a relaxed and communicative atmosphere. Feeding techniques were not observed but the manager and training records confirmed that training in feeding techniques had been undertaken by all staff and that there are continuing discussions with staff and the chef about more appetising presentation of pureed meals. All foods are now pureed separately and presented with this in mind. One resident noted in the survey that they ‘did not like the presentation of food.’ Six of the people who use the service said that the food was good, they had choice and could have what they wanted. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The people who use the service experience good quality outcomes in this area. The home listens to the residents and their representatives and takes appropriate action, it protects them from all types of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has received four complaints since the last inspection, they were appropriately investigated and recorded. Complainants were recorded as making no further contact after they had been informed of the outcome of the complaint. The manager confirmed that the home had noted no safeguarding adults concerns. The Commission for Social care Inspection has received one verbal complaint, considered at the inspection visit and no safeguarding adults information about this service. Six of the people who use the service said that they knew who to talk to if they have a complaint or are not happy. Other residents discuss concerns or things that they are not happy with at the residents’ forum. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 18 Six of the nine surveys received from families said that they ‘ knew how to complain’, three said ‘they didn’t.’ All seven of the residents surveys said they knew how to make a complaint or who to talk to if they are unhappy. The complaints procedure is on the communal notice boards, staff spoken to were aware of the complaints procedure. All staff have received Protection of Vulnerable Adults training (as evidenced in training records and confirmed by staff) and staff were able to detail how they would deal with a vulnerable adults issue, they were clear about avenues to take ‘external’ to the home, if necessary and were clear about their responsibilities of protecting people in their care. Residents finances are either dealt with by themselves, their families or an advocate and the home keep only minimal personal allowance monies in the home. These are held safely and expenditure is accurately recorded with receipts kept. Six of the people who use the service said that they felt safe and two said that they had never been ‘shouted at’ or badly treated by staff although sometimes other residents could be ‘unpleasant’. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The people who use the service experience good quality outcomes in this area. The home provides a pleasant and well-maintained environment that is flexible and able to meet the needs of the residents. It has reduced its double rooms by three to improve the quality of life for the residents. The home is clean and hygienic and staff adhere to the procedures that minimise the risk of cross infection, to safeguard the health of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 20 The home is clean and well presented, many areas have been newly decorated and new carpets are evident in some areas. The home has reduced its double bedrooms from 12 to nine, there are now 43 resident places rather than 46. As the rooms become empty they are decorated and carpets replaced, if necessary. The home has a programme of refurbishment, the decision on whether to retain rooms as double or make them single when they become vacant is made at the time, dependant on size and outlay of the room. One double room on the ground floor is very small and it is expected that this will be made a single room, in time. The home is awaiting a government grant that will replace some other necessary items of furniture, such as high back chairs (as requested by residents). The home has appropriate equipment to assist people who have diverse needs with regard to their physical mobility there are overhead hoists, manual hoists, wheelchairs, safety handrails and grab rails. The kitchen is small but well ordered and clean, the ‘bottom kitchen’ where the washing up and equipment is stored has recently been refurbished. An environmental health visit in June 2007 noted no concerns and gave a good rating, (as advised by the manager), the chef is using the document ‘safe food better business’ issued by the Food Standards Agency to ensure cleanliness and hygiene in the kitchen and is using it as a training aid for other staff. The laundry is well ordered, gloves and aprons are used as appropriate and staff are aware of infection control, there is information and instruction about hygiene and infection control throughout the home. All areas are clean and hygienic, lids are placed on bins, there is a plentiful supply of gloves and aprons and there are adequate hand washing facilities. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. The people who use the service experience good quality outcomes in this area. The home has an effective staff team who are well trained and have the skills and competence to keep the residents safe and meet their needs. The recruitment process makes sure that staff are safe to work with the residents, as far as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has 20 care staff, nine nurses and 13 ancillary staff. The staff are deployed in a way that meets the needs of those living in the home, with more staff being on duty in the morning. There are 11 staff on duty in the morning, seven staff on duty in the afternoon and early evening and four staff on duty from eight p.m to six a.m. The shifts are slightly varied to ensure that there are always enough staff to meet peoples’ needs. Residents can choose when to go to bed but most got to their rooms by eight pm, most prefer to get ready for bed and stay in their rooms for the evening but they can choose not to. One resident said that staff turn her television off Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 22 at 10 p.m and she would prefer to have it on until 10.30 but she has not mentioned it to them. One family survey noted that their relative was not entirely happy that she was helped to her bed by 6.30 p.m because of staff routines, she would prefer it to be bit later.. Ancillary staff work until five p.m but kitchen staff work until eight p.m. Rotas reflected these shift patterns, with extra staffing on duty if needed. The home does not use agency or bank staff, any extra hours are covered by staff doing overtime. The home operates in five units with one nurse supported by care staff working in them, there is a senior care assistant on each unit. There is a registered nurse on duty at all times. The manager is assisted with the training programme, for staff, by an advisor who manages a care home but specialises in organising and sourcing training. Staff have had a recent training and development needs assessment completed by ‘skills for care’ (a specialist training organisation), they have received mandatory training which is all up-to-date and have also had some additional training to meet the needs of particular individuals. The home also uses on-line learning and is part of a ‘learning hub’, which is provided with training by the local authority. It also belongs to the South East Care Advisory Service who advise the home where to access learning and funding for learning. Of the 20 care staff 15 have NVQ 2 or above and three are currently pursuing NVQ qualifications. For many staff English is not their first language and eight of the eight surveys and three of the six residents said they had difficulties with understanding some of the new staff. Three of the seven surveys received from residents noted language and understanding as a major issue in the home. The home tries to ensure staff pursue English language courses and the manager is trying to develop ways to provide some ‘in house’ language training perhaps from existing staff who have mastered the language. This causes residents some frustration and discomfort, the management team and staff are aware of the problems and issues and are working to overcome them. Four files were seen for newly recruited staff and they contained all the necessary paperwork. There was a discussion with the manager with regard to validating references, particularly if they were old or not particularly relevant. All new staff have an induction pack and programme as provided by skills for care. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 23 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 and 38. The people who use the service experience good quality outcomes in this area. The home is well managed in the best interests of the residents. The home ensures that Health and Safety procedures are followed so that residents are as safe as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager has been in post for four years, she is qualified, competent and experienced to manage the home. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 24 The home has a deputy and a ‘training officer’ who support the manager in her role. The Quality assurance system includes regular regulation 26 visits, a report of the visit is kept in the home. Residents’ forums minutes and action plans from the forum meetings are completed, annual questionnaires are sent to residents, their families and staff. Data is collated from the annual questionnaires and other quality assurance forums and an action plan is developed. The last was fully completed in 2005 but information has been collected for a 2007 annual development plan. Over 50 of family questionnaires have been returned and the activities co-ordinator has assisted individuals to complete theirs independently, the results and action plan will be presented to the management team and the residents’ forum. Developments in the home over the past year are evident, such as increased training, continuing environmental improvements, care planning developments and the converting of shared rooms to single rooms. Several day-to-day changes have been made as a result of residents forum such as a large clock for library, change in toileting routine at lunchtime’ upright tall backed chairs on order, more notices of events around the building and changes to the menu. Supervision is not done regularly although supervision mechanisms include daily handovers (records are held of daily handovers where practice and individual care issues are discussed), training sessions or joint supervisions and staff can talk to the manager or deputy manager, if necessary. A system to undertake and record regular, formal supervision sessions and to delegate supervisory responsibilities is being developed. The home only deal with small amounts of personal allowances for people and this is well kept and properly accounted for. Records seen were accurate and receipts are kept for all expenditure. The home has a health and safety file and all maintenance checks are recorded. The Annual Quality Assurance Assessment noted that all necessary checks had been completed on time, the manager confirmed this on the day of the visit. Disposable gloves and aprons are now kept in dispensers on the corridor walls, for easy access for staff. Staff were seen to be changing gloves and aprons frequently, after care routines with individuals. Automatic door closures have been fitted to some bedroom and other doors and the plan is to fit these to all bedrooms, assessments have been done (as advised by manager) to ensure that those people at most risk have the closures fitted first, this work will be completed on a ‘staggered’ basis. The fire officer visited on the same day as the inspection visit and the manager advised that he was satisfied with the fire arrangements but has asked for the fire assessment in a different format. Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 25 Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations To ensure that daily notes evidence the care given by staff is the same as noted in care plans, so that residents receive consistent good quality care, as agreed on the care plan. To ensure that changes or deterioration of conditions is recorded, so that it is clear what has happened, when and what the home is doing about it. To ensure that staff have regular formal supervision sessions that are recorded, to check that staff are performing effectively and offering good quality care. To look at the concerns expressed by residents in the surveys returned to the Commission, to include in the quality assurance information and consider for the development plan. DS0000066749.V344864.R01.S.doc Version 5.2 Page 28 2. OP8 3. OP36 4. OP33 Kingfishers Nursing Home Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Kingfishers Nursing Home DS0000066749.V344864.R01.S.doc Version 5.2 Page 30 - 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!