Inspection on 22/11/05 for Kingsclear Nursing And Residential Home

This inspection was carried out on 22nd November 2005.

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

The inspector 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... 14/06/06

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 11:00 22 November 2005 nd 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.V249334.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 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 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.V249334.R01.S.doc Version 5.0 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 accomodated up to 7 may be in the category DE(E) and one in the category LD. 08 August 2005 Date of last inspection: Brief Description of the Service: Kingsclear is a care home for older people registered to provide nursing and personal care for fifty – five service users and personal care only for twenty service users. The maximum total of service users is seventy-two. Service provision is for permanent, respite and convalescent care. The home is part of a group of seven care homes in Surrey operated by Caring Homes Limited. This organisation is a national care homes provider. The home is served by public transport and is conveniently located close to all community facilities and shops in Camberley. The main building is a large, detached Edwardian house. This has been extended over the years, retaining and combining the traditional characteristics and features of the original building with modern facilities. Bedroom and communal facilities are situated 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 rooms, ten of which have en-suite facilities. The home has five lounges and a central, large dining room, with other dining areas provided on upper floors as an extension of lounges. There is a spacious conservatory, activities room and hair dressing/therapy room on the ground floor. The home is set in approximately 7 acres of land, partially laid to lawn and surrounded by its own woodlands. Ample car parking space is available. All areas of the home are wheelchair accessible and suitable toilet and bathing facilities are provided. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this inspection. It commenced at 11.00hrs and concluded at 18.15 hrs. The inspection was unannounced, meaning staff and residents were not notified in advance of it taking place. This was the home’s fifth inspection in the year 2005/2006 which has included three visits in connection with complaints received by the Commission for Social Care Inspection. The inspection process included a review of progress in meeting the requirements of the last inspection. Although the registered manager was not on duty however discussion took place with her by telephone at the start and conclusion of the inspection. Other staff consulted included the care manager who deputised for the manager in her absence, the nurse in charge of the late shift; other nurses and care staff, the administrator, receptionist and one of the two activity coordinators on duty. The inspector also spoke with eight service users in some depth and had brief conversations with others during the course of the inspection. A relative was also consulted as part of the inspection process. Practice observations were undertaken, also records sampled and a partial tour of the building carried out. Four comment cards were returned following the inspection from relatives/visitors and the views expressed formed part of the inspection process. The inspector would like to thank the service users, visitors and staff present at the time of the inspection for their cooperation and courtesy. What the service does well: Prospective service users and their representatives had access to a range of information including the latest inspection report that was prominently displayed in the home. A service users guide had been professionally produced accurately depicting the home’s service provision. This enabled decisions about admissions to be on an informed basis. Feedback received from a visitor described an empathetic, understanding management approach to the circumstances and feelings of service users and relatives new to the home. The registered manager was commended by this individual for her flexibility and support in enabling this family to personalise their relatives private space with her own furniture, equipment and personal effects. A warm, welcoming and open atmosphere was promoted through provision of helpful, friendly reception staff operating the reception area seven days a week. The prominent location of office facilities by the front entrance occupied by the manager and administrator fostered the accessible, open management style described by a visitor. This style of management enhanced Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 6 communication between the home, service users representatives and with other stakeholders. The care ethos evidently recognised the importance of stimulation to the wellbeing of service users. A varied social and recreational programme was in place, enabling service users to determine their own level of involvement. This afforded a variety of group and individual activities and opportunities for engaging in day and evening social events. Some of these encouraged involvement of relatives/visitors and staff and provision included use of external entertainers. Systems existed for consulting service users and where appropriate relatives in the process for planning the home’s activity programme. Effort was made to accommodate service users individual interests as far as practicable. All grades of staff were observed to be very hard working throughout the course of the inspection. Effective team working was evident and staff relationships appeared positive. A relative regarded the home’s management as good and informed the inspector “the manager is the best, she keeps everyone on their toes”. Another relative stated in the comment card returned “ We are very happy with the manager Mrs Sue Allen and her staff”. Information contained in the comment cards received from relatives/visitors confirmed overall satisfaction with the home’s management and operation. One visitor whose relative had recently moved into the home stated in the comment card that he considered the care at the home to be “excellent”. What has improved since the last inspection? What they could do better: Whilst it is acknowledged that a review of the adequacy of staff hours was carried out following the inspection in September 2004, observations again indicated that staffing levels, staff deployment and routines required Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 7 fundamental review to ensure service users needs were safely and appropriately met. Improvement was required to elements of nursing practice, specifically in the area of pressure sore prevention, to care planning and nutritional risk assessment. Care plans must be reviewed at least monthly and risk assessments relating to care also regularly reviewed. Risks and needs identified must be addressed in care plans. Discussed with the registered manager was the importance of ensuring service users views about their care were adequately taken into account in their care plans and delivery of care. Attention was also required to confidentiality of information held about service users and to moving and handling practices. A review and improvement was necessary to elements of infection control management. This comment is specific to the need to replace a sluice machine that was beyond repair and has not functioned for over twelve months. Also to ensure effective systems for maintaining hygienic hoist slings. Two slings were observed to be dirty and soiled at the time of the inspection. A fire risk assessment must be carried out of combustible items stored in the corridor of one unit. Whilst noting this was not a fire route, storage in this area must take account of risks and be monitored. 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.V249334.R01.S.doc Version 5.0 Page 8 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.V249334.R01.S.doc Version 5.0 Page 9 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, 3, 4, 5 Prospective service users or their representatives had the information necessary to make an informed choice about admission to the home. Preadmission assessments ensured needs were identified and could be met. Opportunity was offered to prospective service users and their representative to visit the home prior to admission to assess the suitability of services and facilities. EVIDENCE: The statement of purpose and service user guide had been professionally produced and was an accurate depiction of the services and facilities at Kingsclear. Service users guides set out clearly the statutory information necessary to enable an informed choice about the suitability of the home to meet needs and preferences. This was stated to be available in each bedroom and included a sample contract of residence, fee charges and tariff of additional charges, also the home’s complaint/compliments and suggestions procedure. The service users guide was prominently displayed near the visitors’ notice board which was located by the reception; also a copy of the home’s latest inspection report by the Commission of Social Care Inspection. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 10 The five care files sampled during this inspection demonstrated comprehensive assessment of needs carried out prior to admission and at the time of admission to ensure needs were met. The care/deputy manager stated that she had delegated responsibility for carrying out most pre-admission assessments. The inspector engaged in discussions with individual service users during the course of the inspection who were at varying stages of adjusting to life in the home. Whilst most expressed preference to be in their own homes, individuals spoke well of staff who they described to be “caring”. Two service users were not of this view however and critical of the care they received. This information was communicated to the registered manager by the inspector. A relative spoke in positive terms about the registered manager who it was stated had been very flexible in meeting his mother’s and family wishes at the time of admission. Specifically for this individual’s bedroom to be mostly furnished with his mother’s own furniture and equipment and arranged in accordance with his mother’s wishes. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 11 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, 10 The home’s procedures and practices required individual needs to be assessed and care plans were formulated and mostly reviewed monthly. Of the small sample of care documentation examined areas for improvement included nutritional assessments, care planning, evaluation of care plans and areas of nursing and care practice. Improvement was also necessary to arrangements for observation of service users and to elements of personal and nursing care practice. EVIDENCE: The service users files were well organised and information was easily accessed. Care plans were formulated from comprehensive assessments of need. Feedback from the small sample of service users consulted by the inspector was variable in terms of opinions about the standard of care they received. One service user stated, “staff do their best”, another stated, “staff are kind”. Observations confirmed that staff were respectful and professional in their approach to service users and delivery of personal care delivery was in private. Two service users independently informed the inspector that some staff “were Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 12 too rough” describing moving and handling practices and one said “some staff who are rough would not like to be moved so roughly themselves and don’t seem to appreciate that I am in constant pain”. Subsequent to this inspection management informed the inspector that no complaint had been received by these individuals in this matter, one of whom who had lived at the home for a number of years. This individual was stated to be adverse to any form of moving and handling by staff, especially use of moving and handling equipment. This had not been recorded in care documents. Concerns were identified regarding the health care of a named service user and this information communicated at the time to the nurse in charge and to the registered manager. An immediate requirement was made for reassessment of the needs of this individual and for referral for medical assessment of weight loss and pain control. Following this inspection the inspector contacted the care manager for this individual who brought forward his annual review. The inspector identified deficiencies in the nutritional assessments for this individual and failure to appropriately respond to significant weight loss and the nutritional risk assessment score in accordance with the organisation’s own policy. Inadequacies in the control and management of pain for this individual were also identified and failure noted for this factor to be considered in the planning and delivery of care interventions. The care plans and other care documentation for this individual had not been reviewed since September 2005. Some care plans were missing and another care plan evidently inaccurate and out of date for some time though recorded as reviewed on a monthly basis up until September. Observations identified a period of almost a one hour wait for two service users to be transferred from wheelchairs to armchairs in lower house unit. They were transferred from the dining room by a care assistant who then went away to find another member of staff to assist her in the transfer but did not return. Staff passed through this area at frequent intervals and despite another service user drawing to their attention that these individuals had been left in wheelchairs for an excessively long period of time and the visible distress of one of the two individuals left sitting in wheelchairs, after giving assurances they would come back, they failed to do so. The inspector could not find staff working in this area to inform at the time. Eventually the two activity coordinators, who were both new in post, responded to the situation. Though having undergone moving and handling training they acknowledged their inexperience. The moving and handling practice observed in their transfer of one service user to an armchair was unsafe, though well – intentioned. Eventually the activity coordinators’ managed to attract the attention of two care staff that safely transferred the second service user to her chair. Service users in bedrooms were sat for lengthy periods without contact and interaction with staff that were observed to be very busy throughout the inspection. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 13 Some care documentation required updating and review. Inspection observations of a sample of care documentation identified improvement necessary to practice and record keeping specific to the prevention of pressure sores. It is acknowledged that this area of nursing activity was being developed and the home had recently obtained input from a tissue viability nurse. Nurses had recently benefited from wound care refresher training. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 The home meets each of these assessed standards well, promoting a stimulating care environment to the benefit of service users wellbeing. EVIDENCE: The home’s marketing information and care ethos recognises that social and recreational activities play an important part of life at the home to the benefit of service users wellbeing. Two activity coordinators had been recruited since the last inspection. They were observed to be enthusiastic and well motivated to make provision of an appropriately stimulating environment. A new receptionist was also employed in the delivery of the activities programme one day a week. 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 programme was observed to provide stimulating group and individual activities including 1:1 time for activity organisers to engage service users in conversation who do not choose or are incapable of joining in the activity programme. The week’s activity programme was prominently displayed on notice boards and it was stated that a personal copy was delivered to each service user in their rooms. The activities room was resourced with activity materials including a piano, Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 15 which some staff were stated to play for the enjoyment of service users. Service users had opportunity to be involved in potting and tending plants and in cookery sessions amongst a range of other stimulating activities. Live music was arranged using the services of an entertainer on the day of the inspection. Regular social occasions were stated to be arranged involving 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. Records demonstrated that relatives and friends of service users visited on a regular basis. A visitor informed the inspector stated he was always made welcome by staff. The reception was staffed seven days a week and afforded a welcoming and helpful atmosphere for visitors to the home. The provision of coffee in this area, inviting visitors to help themselves and a visitor’s notice board, which contained useful information, was considered thoughtful and good practice in customer care. The close proximity of the manager and administrator’s offices to the reception also enhanced communication between the home and relatives/visitors. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 16 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 This standard was only partly inspected owing to circumstances that the registered manager was not available to provide access to complaint records. Systems and procedures were in place for responding to complaints. 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 complaint procedure was available in the service user guide a copy of which was stated to be available in each bedroom. The complaint procedure clarified that at any stage complainants may contact to Commission for Social Care Inspection and contact details for the Commission recorded. Under the circumstances that the registered manager was not on duty, details of complaints, if any, since the last inspection investigated under the home’s complaint procedure was not obtained. There had been three complaints investigated by regulation inspectors from the Commission of Social Care Inspection during this period. These related to health care practices and procedures, odour control, policy and practices for notification of deaths to relatives, medication practices, record keeping and staff competence issues specific to communication and language skills and moving and handling Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 17 techniques. These allegations were part substantiated and requirements made for improvement. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 18 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, 26 The standards of cleanliness, décor and maintenance were adequate overall in the areas inspected with evidence of continuing improvement. Attention was drawn to some deficiencies specific to infection control practices. EVIDENCE: The care environment was ‘fit for purpose’, overall satisfactorily maintained and clean. Cleaning was in progress throughout the inspection and housekeeping staff were observed to be very hardworking. Effort was being made for the effective management of odour. Work was in progress on lower meadowcroft unit undertaken by the maintenance employee, for alteration to the access route to the sluice room. The sluice machine in this unit was noted to be non functional and to be beyond repair and this was stated to be a longstanding problem. Whilst staff had access to a sluice in another unit it was necessary to assess and record infection control risks specific to the far proximity of some bedrooms to the nearest sluice machine. The registered manager stated that there was long term plans for relocation of a sluice machine to this unit from another unit planned to coincide with the demolition Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 19 of that unit as part of a new building project. The registered manager was not informed of any projected timescale for this work to commence. Consultation with the Group Property Services Manager following the inspection confirmed that the planning application process had not yet concluded. It was anticipated this would likely to be in January 2006 and the building work would commence thereafter without delay. Observations identified attention necessary to infection control risks specific to two hoist slings in use that were dirty and stained with bodily fluids. The home did not have a formal system with designated responsibility for daily inspection of the cleanliness and hygiene of slings. Observation was made additionally of a visitor carrying a soiled flannel left on the wash hand basin in his relative’s bedroom, brought to the office to show the nurse in charge. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 20 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, 30 Staffing levels or deployment of staff did not appear adequate to meet the needs of service users based on observations at the time of this inspection. Immediate requirement was made for review of staffing levels and staff deployment and of routines, taking into account all relevant factors. EVIDENCE: Observations did not include review of staff training records. Direct observation of moving and handling practices confirmed requirement for less experienced staff to be supported by experienced staff until fully competent and safe practice assured. Increased supervision of moving and handling practices in general is necessary. Information available including direct observations of practice gave the perception of nurses and care staff being at times overstretched and unable to fully meet the needs of service users. Observations made at the time of the last inspection indicated that staffing levels were inadequate. At that time a service user who urgently required the toilet had to wait because the bathroom was occupied and two staff not available to assist this individual to the toilet. On this occasion a service user informed the inspector of long delays in staff attention after asking to be taken to the toilet. This person described this at time resulting in pain, exacerbated incontinence problems and causing this individual to be distressed. It was noted that staffing levels had been reviewed following the inspection carried out in September 2004 at which time staffing levels appeared inadequate. Observations at the time of this inspection Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 21 indicated the need to again review both staffing levels and staff deployment. This review must take into account the complex layout of the premises in addition to dependency levels. Consideration must be given to numbers of service users who require more than one member of staff to meet nursing and personal care needs, and numbers of these individuals cared for in bedrooms, which significantly reduces staff availability and observation levels in communal areas for substantial periods of time. A further factor for consideration in the required staffing review is the operational practice of service users whose bedrooms are located in one unit, choosing to spend much of their time during the day on other units. Whilst clearly this is good practice it can increase the workload of staff on units, which needs to be taken into account in staff deployment decisions. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 22 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, 35, 37, 38 There was a range of management and auditing tools at the disposal of management for assessing standards and quality of care. The outcome of this inspection indicated the need for improvement in monitoring some nursing and personal care practices. Observations indicated that staff received consistent management direction to ensure effective management of the home. EVIDENCE: The home’s management structure includes a registered general manager and care manager who deputised for the manager in her absence. The care/deputy manager was working out her notice at the time of the inspection. Registered nurses were designated senior nurse based on length of service. They took charge of the home in the absence of the registered manager and care/deputy manager. On the day of the inspection the manager was on leave though in contact with the home and the inspector for discussion and feedback on the inspection outcomes. Under these circumstances it was not possible to fully Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 23 assess the standard relating to the home’s management. Positive feedback was received from a visitor regarding the home’s management. Observation made of financial records confirmed systems in place for accounting and safe keeping of service users’ personal finances and possessions. Recommendation was made for the nurse in charge to countersign financial records relating to financial transactions involving service users money rather that the current system of retrospectively signing off these records. Improvement in some care records was required. Attention was also drawn to the statutory requirement for notification to the Commission of pressure sores, grade 2 and above, present on admission or acquired in the home. Though mostly care records were stored in nursing stations, observations confirmed a breach in confidentiality of information through the practice on the unit called house of care records left throughout the duration of the inspection on a dining table in a public area. First aid appointed persons were designated responsibility for coordinating first aid practices and emergency procedures. These individuals were clearly identified also the location of first aid boxes. Accident records were satisfactorily recorded and stored confidentially. It was evident that risk assessments were in place for identifying service users’ at risk of falls and these risks addressed in care plans. A fire risk assessment was required to be carried out of materials including combustible items stored in the corridor on lower meadowcroft unit. Whilst it is acknowledged that this corridor is not fire exit route, storage in this area requires strict monitoring controls to identify and address fire safety hazards. On the day of the inspection, in addition to the storage of furniture and cleaning equipment, fibreglass insulation material was stored in this area. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 24 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 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 x x x x x x 2 STAFFING Standard No Score 27 1 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x 2 Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP37OP8O P7OP 7, 8, 37 Regulation 14(2)(a) (b)15(2) (b) Requirement For general improvement in practices for evaluation of care objectives and reviewing care plans, ensuring needs and risks are fully and accurately assessed and their management underpinned by care planning processes. Care plans must be reviewed at least monthly. For a comprehensive assessment of needs to be carried out for a named service user and referral to the general practitioner for review of weight loss and pain management. The care plans for this individual also must be reviewed to ensure details of the action which needs to be taken by nurses and care staff to ensure all aspects of this person’s health, personal and social care needs are met. For review and improvement in nursing practice and record keeping relating to pressure sore prevention. For a fire risk assessment to be carried out of items including DS0000017620.V249334.R01.S.doc Timescale for action 22/12/05 2 OP37OP8O P7OP 7, 8, 37 12(1)(a) 14(2)(a) (b) 24/11/05 3 OP37OP8O P7OP 7, 8, 37 OP38 12(1)(a) 13(4)(c) 23(4)(a) 29/11/05 4 29/11/05 Kingsclear Nursing And Residential Home Version 5.0 Page 26 5 OP38OP26 13(3) 6 OP38OP26 13(3) 7 OP27OP 27 12(1)(a) (b) 18(1)(a) combustible material stored in the corridor in lower meadow croft unit. For a formal risk assessment to be carried out and copied to the Commission for Social Care Inspection specific to infection control hazards relevant to the proximity of bedrooms from sluice facilities. For a system to be in place to ensure regular inspection of the cleanliness and hygiene of hoist slings. For staffing levels, also working practices and routines to be fundamentally reviewed to ensure at all times that, having regard to the size and layout of the home, in addition to dependency levels and numbers of service users, that suitably qualified, competent and experienced persons are working at the home with adequate supervision, in such numbers as are appropriate for the health and welfare of service users. A report on the outcome of this review outlining the review methodology and demonstrating consideration of all relevant factors and any proposals for change to be forwarded to the Commission for Social Care Inspection by this timescale. For notification of pressure sores of grade 2 and above to the Commission for Social Care Inspection. For secure storage of care records in accordance with the Data Protection Act 1998. 22/12/05 29/11/05 05/12/05 8 OP31OP 31 37(1)(e) (2) 17(1)(b) 23/11/05 9 OP37OP31 OP 37 23/11/05 Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 27 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 OP35OP 35 Good Practice Recommendations For records relating to transactions involving service users personal finances to be countersigned at the time by the person in charge of the home and not retrospectively by the manager. Kingsclear Nursing And Residential Home DS0000017620.V249334.R01.S.doc Version 5.0 Page 28 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.V249334.R01.S.doc Version 5.0 Page 29 - 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. 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