Inspection on 14/06/06 for Kingsclear Nursing And Residential Home

This inspection was carried out on 14th June 2006.

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

Kingsclear Nursing And... 31/01/08

Kingsclear Nursing And... 22/11/05

Kingsclear Nursing And... 08/08/05

Kingsclear Nursing And... 09/12/04

Kingsclear Nursing And... 28/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Kingsclear Nursing And Residential Home Park Road Camberley Surrey GU15 2LN Lead Inspector Pat Collins Unannounced Inspection 14th June 2006 07:45 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 Kingsclear Nursing And Residential Home DS0000017620.V299673.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. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsclear Nursing And Residential Home Address Park Road Camberley Surrey GU15 2LN 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) 01206 828290 01276 691228 admin@caringhomes.org Kingsclear House Limited Susan Mary Allen Care Home 72 Category(ies) of Dementia - over 65 years of age (7), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (72) Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 52 beds providing nursing care for elderly people from the age of 60 years The number of persons for whom residential accommodation with both board and personal care is provided at any one time shall not exceed twenty (20) Of the 72 service users accommodated up to 7 may be in the category DE (E) and one in the category LD. 22nd November 2005 Date of last inspection Brief Description of the Service: Kingsclear Nursing and Residential Home is a care home providing nursing and personal care for older people from the age of 60 years. Service provision includes permanent, convalescence and respite care. The home is part of a group of seven care homes in Surrey operated by Caring Homes Limited. These homes are part of a wider network of care homes, specialist centres and independent hospitals in England and Scotland operated by the same organisation. The home is located in a quiet residential area convenient for Camberley town and all community facilities. The building is a large, detached Edwardian house that has been extended over the years. The original architectural features of the main house have been tastefully combined with the modern, purpose built facilities. The home is set in 4 acres of landscaped grounds and has ample car parking facilities. Bedroom and communal facilities are on three floors, accessible by stairs and passenger lifts. For operational purposes the home is divided into five living units though service users have choice of where they sit during the day. Most bedrooms are single occupancy and ten have en-suite facilities. There are five lounges also a large dining room on the ground floor; a number of combined lounge/dining areas are also available on all floors. The accommodation includes a spacious conservatory, also an activities room and hair dressing/therapy room. All areas of the home are wheelchair accessible and provision includes suitable assisted toilet and bathing facilities. A full time registered nurse-manager is responsible for the day-to-day management of the home. Weekly fee charges ranged between £580 and £685 for personal care placements and £685 and £785 for nursing placements as of May 2006. Additional charges applied for private physiotherapy, hairdressing, chiropody, Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 5 dental and ophthalmic services and beauty treatments. Also for newspapers, staff escorts, outgoing telephone calls, dry cleaning, outings and transport. Prospective service users and their representatives are informed about the services and facilities of Kingsclear in literature available at the home. A copy of the home’s latest inspection report is publicly displayed in the home and available from the Commission for Social Care Inspection (CSCI). Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of the home in 2006. It draws together the cumulative assessment, knowledge and experience of service provision at the home since the last inspection in November 2005. It also takes into account the findings of an unannounced inspection visit undertaken by one regulation inspector on 14th June 2006. The duration of this visit was eleven and a half hours and all key national minimum standards for older people were inspected. A tour of the premises was carried out and records, policies and procedures were examined. Discussions took place between the inspector, the home manager and also the regional manager who was present for most of the inspection. The inspector also consulted members of staff, some service users and visitors. Individual service users had varying degrees of memory impairment. Judgements regarding the wellbeing of individuals unable to express opinions about their care have been based on their demeanour and appearance at the time of the inspection visit and information gained from records and staff. Comment cards received from 11 service users, 4 relatives/visitors and 1 professional also informed the inspection. The inspector would like to thank everyone who contributed to the inspection process for their time and cooperation. What the service does well: Prospective service users and / or their representatives had access to a range of professionally produced information about the home. This included a brochure also statement of purpose in which the service aims and objectives and philosophy of care was set out and the services and facilities of the home described. Other information provided included a specimen contract of residence, the complaint procedure, details of fees and tariff of additional charges. A summary of this information was contained in a service users guide document available in all bedrooms together with a programme of social activities. This information enabled an informed choice as to the home’s suitability to meet individual needs. Admissions to the home were on the basis of a comprehensive needs assessments carried out prior to admission, ensuring needs can be met. Care plans generated from needs assessments were holistic and where appropriate reflected the cultural, religious and social preferences of service users Activity coordinators were employed, providing meaningful activities and experiences for service users. Visiting hours were flexible and at the time of the inspection visitors were made welcome by staff. The chef and assistant chef were aware of and met service users’ individual dietary needs and preferences. The menu was varied, balanced and appeared nutritious, Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 7 affording choice of meals. Food was served to meet the need of all service users including those with swallowing or chewing difficulties. There was evidence of nursing and personal care being well organised and recorded. The care plans sampled were comprehensive in content, each addressing health, personal and social care needs. Care plans were underpinned by clinical guidance and risk assessments and subject to regular review. Staff were observed to respect service users’ privacy and dignity in the delivery of care. There was evidence of good rapport between individual staff and service users. Staff were also noted to be professional in their appearance and conduct and a relevant training programme underpinned their practice. The home’s policies, procedures and practice guidance focused on service users being in control of their lives within individual capabilities. Staff encouraged and supported service users in maintaining their independence commensurate with individual capacities. A service user described staff at the home as “the best………..they are all excellent and work very hard”. Another service user who had recently moved into the home commented in positive terms about its operation and routines. She reported looking forward each day to the optional cooked breakfast which was described as “very good” and said that all meals were to her satisfaction. She also stated, “ the atmosphere of the home is relaxed and friendly, I come and go as I please around the home and in the garden. I join in and enjoy most activities and am very satisfied with standards of cleanliness and with the laundry service. All staff respect my privacy which is most important to me”. What has improved since the last inspection? It was positive to observed the substantial improvement in care records, care plans and documentation of risk assessments. Improvement was also noted in pressure sore prevention and treatment practice and record keeping. A new chef and assistant chef had been appointed who were both suitably qualified and experienced. Discussions with catering staff and nurses and observations of care records confirmed a holistic approach to meeting service users’ nutritional needs. The menus had been further developed in consultation with service users and appeared well balanced, affording choice and a variety of food. Special dietary needs were being met and the chef had introduced additional food supplements aimed to provide a high concentration of nutrients for meeting individual needs. The presentation of meals was good on the day of the inspection visit and service users consulted were mostly satisfied with catering standards. Systems were in place for responding to suggestions or comments about meals. Other improvements had enhanced infection control, fire safety arrangements and confidentiality of records. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 8 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. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 9 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 Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Good quality literature about the home’s services and facilities was available to inform prospective service users and /or their representatives. This enabled an informed choice of home suitable to meet individual needs. Systems were in place to provide contracts/statements of terms and conditions of residency and information about fees and additional charges to service users and/ or their representatives. Comprehensive needs assessments formed the basis of all admissions. EVIDENCE: The home’s statement of purpose and service users guide documents were both displayed in the reception area of the home and in corridor near the reception where there was a visitors notice board and other useful information. The statement of purpose and service users guide documents contained all statutory elements and accurately depicted service provision. The service users guide document was also available in all bedrooms. These documents and the Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 11 brochure enabled informed judgements about the home’s suitability to meet the individual needs of prospective service users. The complaint procedure, a specimen contract of residence and details of fees and additional charges was also included in an information pack available for prospective service users. A copy of the latest CSCI inspection report was prominently displayed, also menus and the activity programme. At the time of the inspection visit an application for variation of the home’s conditions of registration (categories) was being processed by the Commission of Social Care Inspection (CSCI). This would provide a small number of places for service users who have sensory impairment. It is recommended that consideration is given to how service users with visual impairment access information about the home. In practice arrangements for admission to the home were commonly made by relatives/representatives of service users on their behalf. Noting that of the 11 comment cards returned by service users after the inspection visit, 8 stated they had not received adequate information about the home it is suggested that management could consider measures to facilitate prospective service users’ access to information about the home, enabling an informed decision. One consideration could be to include in pre-admission assessment procedures the distribution of the service users guide and brochure direct to prospective service users if they have not had opportunity and would like access to this information. Arrangements were confirmed for informing service users and/or their representatives of the amount of nursing contribution to be paid in respect of nursing care; also for deducting the same in the calculation of fees. Service users who were self funding had been issued with contracts. The manager confirmed systems for issuing a statement of terms and conditions of residency to service users funded by ‘sponsoring’ agencies. This ensured they were also informed of their rights and obligations of residency and of any additional charges. It was stated to be the practice for a copy of this statement to be retained on service users’ file. A number of files sampled however did not contain a copy of this document. The manager was confident these had been issued and this was an oversight. Pre-admission assessments were carried out for all service users prior to admission. A summary of health and social care assessments was also obtained for individuals funded by care management or by continuing care arrangements. On the files sampled pre-admission assessments had been fully completed and were comprehensive in content. Staff had the necessary information to prepare for admissions and to ensure any necessary equipment was available; also to be able to produce preliminary care plans. Admission procedures included comprehensive assessment of risks from which care plans were generated as necessary. Records included medical information and reports from relevant professionals involved in the care of each service users Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 12 prior to admission. Service users or their representatives were requested to provide a biography to assist staff in meeting individual aspirations and expectations relating to social and leisure activities and for meeting cultural, religious and diversity needs and preferences. Staff were competent, skilled and experienced to meet the needs of a prospective service user. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that service users received was in accordance with individual needs. It was positive to observe significant improvement in record keeping relating to care documents; also developments specific to the prevention and treatment of pressure sores. The principles of respect, dignity and privacy were being put into practice and medication policies, procedures and practices were overall satisfactory. EVIDENCE: The inspector carried out a process of case tracking the care pathways of three service users and the findings used to form judgements regarding quality in this outcome area. All of these individuals had been admitted to the home on the basis of full needs assessments carried out in advance of their admission. All relevant risk assessments had been conducted including pressure sore risk assessments falls, moving and handling and nutritional assessments. These service users had holistic, comprehensive care plans, which were reviewed at least monthly. Weights were recorded and monitored and as required care plans produced to address weight loss or special dietary needs. Significant Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 14 improvement in care plans and risk assessments was demonstrated since the time of the last inspection. Observations of arrangements at the home for the storage, recording, administration and disposal of medication including controlled drugs were base on practice observations in Lower Meadow unit. Overall this was adequate though some areas for improvement identified. Specifically for staff to ensure reasons for non-administration of prescribed medication is recorded on medication charts and for protocols to be produced underpinning administration of medication prescribed for administration ‘as required’ to promote consistency. Areas of discussion with the manager included the future intention to implement a change in medication administration responsibilities. This will permit suitably trained care staff to administer medication to service users accommodated for provision of personal care. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home meets each of these assessed standards well, promoting a stimulating care environment to the benefit of service users wellbeing that is welcoming to visitors. Service users receive a varied diet, which affords choice of meals and is suited to individual assessed and recorded needs and preferences. EVIDENCE: The home’s marketing information and care ethos recognised the importance of social and recreational activities to the wellbeing of service users. One full time and two part-time recreational therapy workers were employed in the delivery of a stimulating programme of group and individual activities. The taking of biography information formed part of the home’s admission procedures. Records examined demonstrated collation of life history information and details of service users interests and former hobbies. This was taken into account in planning the activities programme where practicable. The week’s activity programme was prominently displayed on notice boards throughout the home and a personal copy was available in bedrooms. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 16 The activities room was resourced with activity materials including a piano. Service users with an interest in gardening had opportunity to engage in potting and tending the home’s plants. A wide range of stimulating activities was available including cooking sessions, general knowledge quizzes, reminiscence sessions and provision of external entertainers. Regular social occasions were arranged inviting visitors and special occasions such as birthdays and anniversaries were celebrated. It was understood that the home had its own transport and driver for excursions. It was positive to note that recreational therapy staff made time to sit and talk with individuals’ who were not interested or capable of participating in group activities. They also afforded service users who required wheelchairs opportunity to go out in the garden. Massages, manicures and hairdressing services were available. On the day of the inspection visit a group of service users engaged in a craft based activity designing posters for and discussing the forthcoming World Cup football tournament over a glass of shandy. A trolley shop was available twice weekly for service users use. Observations confirmed arrangements made for meeting the individual religious needs of service users where possible. This was fully discussed as part of the admission procedures. Since the last inspection a new chef and assistant chef had been employed. At the time of the inspection visit during a meeting with the chef it was demonstrated that catering standards were well met. The chef demonstrated relevant knowledge and experience to enable provision of a varied nutritious diet that ensured all dietary needs were met. The menu was observed to afford choice of meals and special diets included vegetarian, diabetic, low and high calorie. Observation of care records confirmed a holistic approach to meeting service users nutritional needs. The presentation of food including pureed and soft food diets was to a good standard and meal portions substantial in accordance with individual preferences. A system was in place for identifying food preferences and for communicating this information to catering staff. The chef had implemented a daily communication book for staff and service users to record feedback and any comments or suggestions about meals. The chef was observed to check this book at the time of the inspection. Meetings were convened affording service users opportunity to discuss meals with the chef and contribute to menu planning. The chef was noted to also have contact with service users unable to attend this meeting to illicit their views. The chef and assistant chef were both very positive in their feedback about the management of the home which they considered supportive to their role and responsibilities for provision of a suitable, well balanced and nutritious diet for service users. They regarded the kitchen to be suitably equipped though it was noted that the recent breakdown of a freezer was creating food storage problems. A fridge was also in need of repair though the chef stated this was less of a problem for staff in food storage than the freezer. The kitchen area was well organised, clean and hygienic on the day of the inspection visit. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 17 Meals were served in the ground floor dining room, in lounge/dining areas on all floors and in bedrooms. Relatives and friends could dine with service users by prior arrangement. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users have access to a robust, effective complaint procedure. Their legal rights are protected and they are safeguarded from abuse. EVIDENCE: The complaint policy was included in service users terms and conditions of residence contract. The home’s complaints/compliments and suggestions procedure made clear that the registered manager was responsible for ensuring that service users and their visitors were informed of their right to complain and of how to make a complaint. The manager confirmed this was verbally explained to service users ensuring individuals with impaired vision were informed. The complaint procedure was available in the service user guide a copy of which was available in the bedrooms sampled. The complaint procedure clarified that at any stage complainants may contact to Commission for Social Care Inspection and contact details for the Commission supplied. The four relatives/visitors who returned comment cards all were aware of the home’s complaint procedure. Ten of the eleven comment cards received from service users confirmed service users’ awareness of the complaint procedure. Two complaints had been investigated under the home’s complaint procedure since the last inspection. Both had been evidently managed effectively and with sensitivity. One complaint had not been concluded thought evident that progress was being made to resolve the issue raised by the complainant. This Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 19 was outside of the manager’s direct control. The second complaint was concluded and it was evidenced that staff had learned from the process and action implemented to ensure issues did not reoccur. There had been no complaints about the home to the Commission for Social Care Inspection since the last inspection. Observations identified the need for some improvement in complaint record keeping to provide a full audit trail of investigations and outcomes. This was discussed with the manager. The home had an adult protection policy and procedure and a copy of the multi-agency safeguarding vulnerable adult procedures. The organisation’s whistle blowing procedure was included in a staff handbook, which was issued to all new staff. A notice was also on display on the staff notice board providing external management contact details for any staff that may have concerns they feel unable to raise through line management. Observations confirmed that the home’s whistle blowing procedures operated effectively. Discussed with management for their consideration was the suggestion to also include on the notice contact details of relevant external agencies. The induction programme for new staff included an adult protection awareness session and video learning. Vulnerable adult workshops and discussion formed part of the home’s training programme for all staff. There had been no referrals investigated under the multi-agency safeguarding vulnerable adults procedures since the last inspection. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enabled service uses to live in a comfortable, clean, safe and suitably equipped environment that facilitated independence. Whilst it was positive to note a programme of routine maintenance, redecoration and ongoing upgrading work, on the day of the inspection visit there was outstanding maintenance work and a number of appliances requiring repair or replacement. EVIDENCE: The physical environment of the home was considered overall ‘fit for purpose’ and a programme of redecoration and upgrading work ongoing. At the time of the inspection visit bedrooms were being redecorated, and paintwork being refreshed to doors, corridors and ceilings. Work was in progress also to convert a ground floor bathroom into a shower room. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 21 Overall the home was clean and comfortable and wheelchair accessible throughout. The bedrooms viewed had been tastefully decorated and were suitably and comfortably furnished and personalised. The emergency call bell system was accessible to service users and fully functional. A range of adaptations and equipment was available including height adjustable beds, bedrails and protective bumpers, pressure-relieving equipment, grab rails, raised toilet seats, hoists and assisted toilet and bath facilities. Feedback received by the inspector from staff of the need for an additional specific type of hoist was communicated to the manager for review. Observations confirmed health and safety risk assessments and audits were routinely conducted which included risk assessment of the grounds. Areas of discussion with the manager included the risk assessment for the for the pond which was only partially cordoned with a safety barrier. The home manager emphasised this did not pose a risk to service users as they used the garden under direct supervision of either staff or their relatives. Likewise the overgrown area with trip hazards in the garden known as ‘Dingley – Dell’ though not cordoned off was stated by the manager to be low risk to service users for the same reason. It was agreed however that this would be included in any future health and safety risk assessment. It was noted that arrangements were being made for volunteers to tidy this area. The remainder of the extensive grounds was well maintained affording a pleasant area for service users’ pleasure including patios. Areas of discussion with management included outstanding maintenance and repairs. Records of meetings confirmed that senior management was aware of the same and management systems ensured follow up on outstanding maintenance issues. The inspector noted several bathrooms could not be used for a variety of reasons. A replacement pump was also stated to be awaited replacing the existing one to resolve recurrent problems with water pressure, which caused sluice machines to malfunction. A carpet shampoo machine, a fridge, freezer and two washing machines also required repair or replacement. Other remedial work to a gas appliance and a boiler in Wellard unit was outstanding. During the inspection visit observations confirmed the need to redecorate and replace floor covering in a ground floor toilet near the dining room. Also for attention to the loose toilet seat. Infection control procedures and practices relevant to care and nursing practices were satisfactory. Cleaning and laundry arrangements and practice ensured the home was clean and hygienic, also odour well controlled and an efficient, hygienic laundry service. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff recruitment procedures protected service users and a programme of staff training ensured staff were competent. A programme of national vocal training for care staff was ongoing working towards compliance with national minimum standards. Staffing levels were consistently operating in accordance with company calculations for determining staffing ratios. Whilst acknowledging a comprehensive review of the adequacy of staffing levels took place since the last inspection, feedback received from some staff and individual service users suggested times when staffing levels in some units were stretched. EVIDENCE: The staff rota inspected at the time of the inspection visit confirmed the home was consistently staffed with three registered nurses across the waking day excluding the manager; also nine care staff on the morning shift and eight on the afternoon/evening shift. Two nurses were employed on night duty and five care staff. At the time of the inspection visit there were 56 service users resident in the home. Staff were professional in the appearance and conduct and were observed to be warm and caring in their approach towards service users. Feedback from individual service users demonstrated a high level of appreciation of staff, describing them as “wonderful” and stating “ they could not be better”. A service user in a comment card sent to the inspector asked that the report Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 23 “simply reflects my experience that if stars could be awarded that in her personal opinion that the home deserved five”. Whilst some nurses and care staff were very positive about all aspects of their work, others expressed the view that the staffing levels on Wellard and Lower Meadow units was at times insufficient. A nurse stated that her clinical practice was sometimes adversely affected by competing demands on her time. This information was communicated to management at the time of the inspection feedback. Most of the comment cards received from service users or relatives/visitors did not indicate staffing levels were inadequate. One service user however did state that staff were usually too busy to act on what this individual said. It is acknowledged that following the last inspection by the Commission for Social Care Inspection that management undertook a fundamental review of staffing levels. This took into account observations of practice, quality care outcomes and review of accidents and complaint records. The internal review also took into account feedback from service users, visitors and visiting professionals. Additionally, information elicited from ‘exit’ interviews of former staff and feedback from the staff team. It was stated that changes had since been implemented to optimise the care hours available by delegating specific non-care duties carried out by care staff to ancillary staff. On the day of the inspection visit however care staff had resumed responsibility for these tasks whilst complaining to the inspector they had not had time for a break. This was drawn to the attention of management by the inspector. Discussions between the inspector and management confirmed that nurses were regularly afforded opportunity to suggest changes to routines and practices to promote effective time management strategies. There were management systems for ongoing review of service users’ dependency and of staffing levels. Efforts to recruit care staff for ‘twilight’ shifts to increase staffing levels during peak periods were stated to have been unsuccessful. It was noted that a staff survey was imminently due to be sent to all staff. The staff-training programme included National Vocational qualifications in care (NVQ). Seven staff had attained NVQ qualifications at Level 2 or above. The manager was aware that this did not comply with the national minimum standard for a minimum ratio of 50 of care staff to have NVQ Level 2 qualifications or equivalent. Records of staff meetings confirmed the manager was actively promoting interest in NVQ training. The manager confirmed that there was one staff vacancy for a nurse and she was currently processing applications for two care staff vacancies. Personnel records sampled confirmed statutory vetting procedures carried out prior to new staff taking up post. Areas of discussion with management included a suggested amendment to enhance the application forms and requirement to maintain a Criminal Records Bureau record for the team. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 24 Observations confirmed a comprehensive programme of statutory and service specific training for all staff. A registered nurse was designated responsibility for coordinating training in the home. The regional training manager was stated to have recently carried out an audit of training at the home. The report of the audit however could not be located at the time of the inspection. Records of training sampled evidenced statutory training for all staff and clinical refresher training updates for nurses were being addressed through recent training sessions. Dementia awareness training was stated to be provided by a registered mental health nurse on the team. It was positive to note plans being made for all staff to receive equality and diversity training. It was noted that work was in progress to implement common induction and foundation standards. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has the required qualifications and experience to manage the home and the home’s administration was competent. Quality assurance and monitoring systems were effective and accounting and financial systems ensured efficient business management. The home’s policies and procedures and record keeping safeguarded service users best interests, safety and welfare. EVIDENCE: The general manager was a qualified nurse with relevant experience and was registered by the Commission for Social Care Inspection. She also had attained the registered managers award qualification in management and care NVQ Level4. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 26 The management structure had been revised since the last inspection and now included two team leader posts held by two registered nurses. This was a very recent development. Both team leaders were registered nurses who now had delegated areas of responsibility. Their roles were still being developed and the manager stated her intention to provide team leaders with one day a week supernumerary time in due course to enable them to develop their roles and fulfil their new responsibilities. If they so wish and able to do so, service users were supported in taking responsibility for managing their own money and provision made of a lockable facility in bedrooms. Whilst safekeeping of money could be arranged in the office the home did not take responsibility for valuables even if itemised on a property list or kept in the safe. Service users and their relatives were therefore encouraged to make alternative arrangements for the safekeeping of valuables. Observation made of financial records confirmed systems in place for accounting and safe keeping service users’ personal finances and possessions. The home had sound policies and procedures. Significant improvement in care documentation was noted since the time of the last inspection. Also in practice for safeguarding confidentiality of information specific to the storage of care records. As previously stated in the report the home must implement a record of Criminal Record Bureau Disclosures for the team containing information in accordance with CRB policy. A range of management and auditing tools was at the disposal of management and used to assess standards and the quality of care at the home. The regional manager confirmed frequent unannounced visits to the home in addition to statutory visits. Reports generated from the latter were present in the home and copied to the Commission for Social Care Inspection. Observations during the inspection confirmed the ethos of the management of this organisation was open and transparent and feedback from staff at the home was evidently listened to and valued. The home operated to a clear health and safety policy and regular audits were conducted to ensure safety at work and of the care environment. Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x 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 2 3 2 3 x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x 2 3 Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 28 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. 1. Standard OP1 Regulation 13(2) Requirement For the registered person to ensure medication record keeping practices denote reasons for non - administration of prescribed medication. For the registered person to ensure all equipment is maintained in good working order. For the registered person to ensure bathroom/shower facilities are in good working order and bath hoists compatible with baths. For the registered person to ensure that the ground floor bathroom near the dining room is reasonably decorated and the loose toilet seat receives attention also the floor covering replaced. For the registered person to ensure that a minimum ratio of 50 of care staff trained to NVQ Level 2 or equivalent are employed at the home. An action plan for compliance must be sent to the CSCI within this timescale. For the registered person to DS0000017620.V299673.R01.S.doc Timescale for action 15/06/06 2. OP19 23(2)(c) 14/08/06 3. OP21 23(2)(b) (c) (j) 14/09/06 4. OP21 23(2)(b) (d) 14/09/06 5. OP28 18(1)(a) (c)(i) 14/09/06 6. OP37 19 (2)(a) 14/09/06 Page 29 Kingsclear Nursing And Residential Home Version 5.2 Sch 2 make available for inspection a record of staff CRB Disclosures. 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 OP1 Good Practice Recommendations For the registered person to consider implementing the practice of confirming with prospective service users where practicable, at the time of carrying out preadmission assessments that they have had access to information about the home. Where they have not to supply them with the relevant information if required. For the registered person to consider producing information about the home, including the service user guide, complaint procedure, menu, contract and activities programme in formats accessible to service users with impaired vision. For the registered person to review practice and agreements for involving service users and / or their representatives in reviewing care plans in order to clarify expectations regarding frequency. Also for record keeping practices to demonstrate their involvement. For the registered person to consider producing medication protocols as appropriate for administration of medication prescribed ‘as required’. 2 OP1 3 OP7 4 OP9 Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Kingsclear Nursing And Residential Home DS0000017620.V299673.R01.S.doc Version 5.2 Page 31 - 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. 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