CARE HOME ADULTS 18-65
Kingsbury House Care Home 103 Mansfield Street Sherwood Nottinghamshire NG5 4BH Lead Inspector
Jayne Hilton Unannounced Inspection 7th November 2005 09:30 Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 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 Kingsbury House Care Home DS0000002301.V253777.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 Adults 18-65. 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. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kingsbury House Care Home Address 103 Mansfield Street Sherwood Nottinghamshire NG5 4BH 0115 955 2917 0115 955 2919 kingsbury.carehomes@ntlworld.com 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 Andrew Richard Schofield Ann Schofield Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th June 2005 Brief Description of the Service: Kingsbury House care home is registered to accommodate up to 11 people who have experienced mental health problems.The home comprises of two separate semi-detached properties. 105 Mansfield Street can accommodate up to three people. It has bedrooms to the ground and first floor, a shared lounge and dining kitchen. One staff member lives in at the property.103 Mansfield Street provides an additional 8 bed spaces. Accommodation is arranged on two floors. There is a non-smoking dining room and a lounge where smoking is permitted. Currently one staff member lives in at the property. Sleep in accomodation is also provided for staff. None of the rooms have ensuite facilities.The home is situated in a residential area of the city within easy walking distance of a range of shops and public amenities. Off street car parking is available.The homes were previously registered separately however the Commission has granted an application to vary this by combining the registrations as one.The proprietor is Mr A Schofield and the Registered Manager is Mrs Schofield. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Monday 7th November 2005 at 9.30am. The Regulation inspector who undertook the inspection was Jayne Hilton. The focus of the inspection was to assess the requirements and recommendations set at the previous inspection and any remaining key standards not assessed at the previous visit. The methodology used included a part tour of the environment, speaking with two staff members, two service users and sampling records for example, two care plans, medication records, fire safety records, water temperatures and menus. The registered manager was not available for this inspection due to personal circumstances. All of the key standards apart from standard 16 were assessed at the last inspection; therefore the reader needs to take into account the overall assessment for the previous twelve months over the two visits. What the service does well:
Service users have opportunity to engage in leisure activities and belong to various community groups. They have opportunities for personal development and their rights are respected. Service users maintain family contact and relationships where appropriate, Service users do enjoy their meals and mealtimes and have a healthy and nutritional intake of balanced food items. Service users are aware of their care plans, which contain information about their individual needs and wishes and now show evidence of how the needs have been met by a process of evaluation and monitoring. Service users are encouraged to make decisions about their lives and are supported where necessary to make decisions and take responsible risks. Service users personal and healthcare needs are met and the systems for managing medicines in the home, is overall satisfactory. Service users have expressed their wishes for the end of life and this is well documented. Service users live in a homely environment and have bedrooms to suit the needs, lifestyles and which promote independence and staff support is provided to assist service users to maintain cleanliness of their rooms and bed linen. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 6 Service users contribute to keeping the home clean and hygienic practices were promoted in general. Service users are confident their views underpin all self-monitoring review and development of the home. Record keeping is good. The health and safety and welfare of service users are promoted and protected What has improved since the last inspection? What they could do better:
The service user spoken with said they would like keys to the back door, and one had lost his bedroom door key. This is an area for further work and where service users are assessed as not able to hold keys this should be documented in the service users care plan and the quality monitoring systems need to be
Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 7 further developed further. Service users communal space is somewhat compromised by lack of facilities for meetings, which should be addressed. A medicines fridge should be purchased and the provider is encouraged to continue to refurbish the home as planned. Standard 34 could not be assessed and will be inspected at the next visit. This is in relation to a requirement for all staff files to contain the appropriate documentation. This requirement is therefore carried forward. 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. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not fully assessed at this inspection and were found to be met at the previous visit. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7,8, 9 Service users are aware of their care plans, which contain information about their individual needs and wishes and now show evidence of how the needs have been met by a process of evaluation and monitoring. Service users are encouraged to make decisions about their lives and are supported where necessary to make decisions and take responsible risks. EVIDENCE: Two care plans were examined and found to contain information of what is required to meet the individual needs of service users, their likes, dislikes and requests/aspirations. Service users were clearly involved within the compilation of these and had signed and agreed them. Care plans were reviewed and a process of evaluation and monitoring was now apparent. Daily notes are taken by the staff and are now summarised monthly. There was evidence that service users were involved in decision making in the home, however the facility of resident meetings had been discontinued for various reasons. At the previous visit, service users had expressed to the inspector that they would like meetings to be revised and arranged so that service users can opt out of attending should they wish. A staff member and two service users confirmed that two meetings had been arranged but no one attended
Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 11 Staff demonstrated a good knowledge of the service users and examples of good practice were given to the inspector. There was evidence that the home had supported a service user to find a more suitable placement and that quality of life had improved for others. Service users confirmed they were involved in the day to day running of the home such as helping with cleaning up, tidying rooms and deciding what goes on the menus. Any restrictions imposed are documented on the individuals care plan with the service users signature. Risk assessments were noted in the two plans examined. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14,16, 17 Service users have opportunity to engage in leisure activities and belong to various community groups. They have opportunities for personal development and their rights are respected. Service users maintain family contact and relationships where appropriate, Service users do enjoy their meals and mealtimes and have a healthy and nutritional intake of balanced food items. EVIDENCE: The two service users spoken with were observed to have a positive and interactive relationship with each other. Service users confirmed that their relatives visited the home and that they visit their family and friends in the community. Service users confirmed that they get up at different times and go out as they please. They explained to the inspector their differing interests and community involvement, which include, a community art group, Open door group, run for people with mental health difficulties and Brook St group meetings and chat in at Sherwood Community Centre, car boot sales, walking in the park, card games and visiting the pub for a meal.
Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 13 It was recognised from the inspection that more innovative use of activities has been introduced and has been beneficial to reducing anxiety and boredom for service users. The staff are developing activities programmes with service users, which they will be encouraged to sign and commit to. An example of a programme was seen in place and the service user has achieved goals through this process. Service users reported that they attended a bonfire party at the provider’s house which all enjoyed. A staff member and service users confirmed that holidays for service users has been discussed and there are plans in place for this to be achieved next year. Service users confirmed that any mail received is given to them unopened and that staff assist with reading letters etc and knock and wait to be invited before entering their rooms. Service users reported that staff, treat them respectfully. The service user spoken with said they would like keys to the back door, and one had lost his bedroom door key. This is an area for further work and where service users are assessed as not able to hold keys this should be documented in the service users care plan. The staff and service users had prepared a new four- week cycle of menus, which was on display and offered a choice of two options. The menu offered a nutritious and varied diet, which is important and although service users are encouraged to make their choice, the staff provide guidance to service users to encourage healthy eating options. Staff are currently undertaking training in food and nutrition. Overall there was evidence that the food provision has improved and service users spoken with confirmed this. It was reported that food is delivered on Wednesdays or Thursdays. Stocks of food reflected the meal options on the menu. The staff confirmed fresh fruit and vegetables are purchased daily and that service users shop for these items. Service user’s expressed, a great satisfaction with the food provided. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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, 20, 21 Service users personal and healthcare needs are met; the documentation of healthcare checks has been improved. The systems for managing medicines in the home, is overall satisfactory. Service users have expressed their wishes for the end of life and this is well documented. EVIDENCE: The service users confirmed that they receive support when needed. Evidence was seen of the involvement of a wide range of healthcare professionals that enables prompt referral to other appropriate services, for example, the Dual Diagnosis team. There was evidence that service users access local General Practitioner (GP) services and other resources such as dentists etc and that appointments are recorded in the diary or in daily logs and included in the care plans including ensuring/encouraging an annual well person check for each individual. Some people have regular visits from healthcare professionals such as Community Psychiatric Nurses and Occupational Therapists. This involvement from a wide range of healthcare professionals enables prompt referral to other appropriate services, for example, the Dual Diagnosis team, where necessary. Medication profiles are included in the care plan and include details of medication reviews.
Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 15 The storage facilities of medication and relative procedures were examined. The home has a British National Formulary dated 2005. Records of the temperature medication is stored were examined, these were taken weekly as routine. Insulin was stored in a locked box in the kitchen fridge, which is not, appropriate in relation to, the assessed needs of service users who live in the home. It is recommended that a small fridge be provided in the medication room for this purpose. Staff have undertaken medicine management training, competency assessments are also carried out at intervals and as part of staff supervision. Additional training is provided by, the dispensing pharmacist. A random sample of medication records were checked and found to be satisfactory. One service user who self medicates signs the record himself and appropriate documentation and risk assessments were seen in his care plan. The service user refused the inspector access to his room but staff was able to confirm that a lockable facility and regular checks are made regarding the safe storage of medicines The wishes of service users for the end of their life were very well documented in care plans Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were assessed at the previous inspection and found to be met. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25,26, 27 30 Service users live in a homely environment and have bedrooms to suit the needs, lifestyles and which promote independence and staff support is provided to assist service users to maintain cleanliness of their rooms and bed linen. Service users communal space is somewhat compromised by lack of facilities for meetings, which should be addressed. Service users contribute to keeping the home clean and hygienic practices were promoted in general. EVIDENCE: The registered manager acknowledged at the previous visit that the home is in need of some redecoration and refurbishment. Some areas have been completed since being identified at the last inspection. The registered manager has devised written plan for the redecoration and refurbishment of the home and is reminded to continue with the programme as specified. The communal areas are kept clean overall. A service user showed the inspector his bedroom, which was noted to be well personalised and clean.
Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 18 A rota is now in place for staff to assist service users with room cleaning, bedding changes etc. A privacy lock with an override facility has been fitted to the bathroom identified at the last inspection. Records were examined of water outlet temperatures, which are regulated to 43 degrees. Risk assessments have been carried out for surface temperatures. There is still lack of space for meetings and the planned garage conversion has not materialised as yet. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 EVIDENCE: The manager was not available at this inspection but staff confirmed that the information required by schedule 2 has been collated. The inspector will reassess this at the next inspection. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41,42 Service users are confident their views underpin all self monitoring review and development of the home, however the quality monitoring systems need to be further developed further. Record keeping is good. The health and safety and welfare of service users are promoted and protected EVIDENCE: Quality assurance systems have been implemented in the form of a service user questionnaire. The provider, although not required legally to, as the providers are in day-today control of the home, should carry out regulation 26 type audits and integrate this with the development and financial plans of the home. A sample of records examined, including health and safety records care plans, and medication records were all satisfactory. The health and safety of service users is promoted and protected. The recommendations by the Environmental Health officer are now in place and the temperature of water outlets taken and maintained. Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 21 Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X X X 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Kingsbury House Care Home Score X 3 3 3 Standard No 37 38 39 40 41 42 43 Score X X 2 X X 3 X DS0000002301.V253777.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No [one not assessed and carried forward] 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 YA34 Regulation 19 Requirement Ensure all staff files contain all documentation as specified in schedule 2 of the Regulations. This standard could not be assessed as the manager was not available so has been carried forward to the next inspection. Timescale for action 07/01/06 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 YA16 Good Practice Recommendations Ensure service users are issued with keys to their bedrooms and the main house unless risk assessed as otherwise and that care plans contain documentation regarding this. Provide a fridge in the medication storage room. Continue the programme of refurbishment as specified in the development and maintanence plan Further develop the quality monitoring and auditing systems Use the regulation 26 format to undertake monitoring of action plans 2 3 4 5 YA20 YA24 YA39 YA39 Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kingsbury House Care Home DS0000002301.V253777.R01.S.doc Version 5.0 Page 25 - 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!
