Inspection on 13/07/05 for Kingscourt Nursing Home

This inspection was carried out on 13th July 2005.

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

Kingscourt Nursing Home 15/05/07

Kingscourt Nursing Home 20/07/06

Kingscourt Nursing Home 13/12/05

Kingscourt Nursing Home 14/02/05

Kingscourt Nursing Home 20/05/04

Kingscourt Nursing Home 26/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Kingscourt Nursing Home 12 Newton Lane Hoole Chester CH2 3RB Lead Inspector Wendy Smith Announced Inspection 13th July 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kingscourt Nursing Home Address 12 Newton Lane Hoole Chester CH2 3RB 01244 313201 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Brookaid Limited Care Home 37 Category(ies) of OP - Old Age (37) registration, with number of places Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 37 service users in the category OP (Old age, not falling within any other category) 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 3 Date of last inspection 14th February 2005 Brief Description of the Service: Kingscourt Nursing Home is a purpose built property situated in its own grounds on the outskirts of Chester city centre and close to local amenities in Hoole. It is convenient for the local bus service. Bedrooms are on three floors. There are 37 single rooms, 20 of which have en-suite facilities. Day space is on the ground floor and consists of a large lounge and a dining room with a conservatory leading off. There is also a conservatory at the front of the building. There is an enclosed garden at the rear of the property. A passenger lift provides access to all floors. Assisted bathing facilities are provided on all floors. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over six hours on 13th July 2005. 33 residents were living at the home. Nine were receiving personal care and 24 were receiving nursing care. The home changed ownership earlier in 2005 and has a new manager and a number of new staff. The inspection was carried out using a process of cross referencing the documentation of identified residents following discussion with them, and following the delivery of care and support to them. Staff records were inspected. A tour of the building, including communal areas and some bedrooms, was completed. Information was also taken from the pre-inspection questionnaire completed by the manager. Time was spent in conversation with the home manager and the area manager. Several staff on duty were spoken with. A comments card was received from one resident, who said that she liked the home very much. Comments cards were available in the entrance area of the home but none were received from relatives or other visitors. Six residents and two visitors were spoken with. Residents were mainly positive about the care they received at the home, however some were still feeling a little unsettled following recent major changes at the home. Relatives spoken with were satisfied with the care being provided. Some staff were still feeling somewhat unsettled by the change of ownership and management of the home, but others were finding the changes to be positive. What the service does well: Kingscourt provides care for older people with a wide range of needs and abilities. Some residents require a high level of nursing care and others are independent with some support from staff. The home is conveniently situated for residents to use local shops and other facilities. Visitors are made welcome. The home provides a good standard of meals and lunch time is a social occasion for residents. New care plans, that are clearer and easier to follow, have been introduced. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 6 The manager receives a good level of support from the area manager and a company trainer. What has improved since the last inspection? What they could do better: A number of bedrooms are in a poor condition and need to be improved. The paintwork in the corridors is badly marked in places. The lounge does not provide a pleasing and comfortable environment for residents to sit in. The nurse call system needs to be improved. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 7 Lighting in the ground floor bathroom should be improved. Hot water temperatures in baths and showers must be regulated to ensure safety. Frail residents should be provided with appropriate chairs to enable them to spend time out of bed when their condition is stable. Residents who are confined to bed would benefit from some stimulation such as TV, radio or music. The registered person should consider fitting automatic fire closers to their bedroom doors so that they are able to see staff passing and staff are more easily able to observe their condition. More social activities should be provided for residents. Staff should receive training regarding Adult Protection and Whistleblowing. 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. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 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 standard(s) 1 and 3. Standard 6 is not applicable. Information about the home is provided for prospective residents. Prospective residents are assessed prior to admission being agreed to ensure that the home will be able to meet their needs. EVIDENCE: A Statement of Purpose contains information about the home to comply with schedule 1 of the Care Homes Regulations. This has been updated to reflect recent changes at the home. The manager said that she intends to go out to assess all prospective residents. A pre-admission assessment form is in use and was seen in the care plan of a recently admitted resident. Emergency admissions are not accepted unless sufficient information is received to show that the person’s needs can be met at Kingscourt. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10. Residents needs are set out in their care plans and the standard of the care plans is being improved. Residents’ health needs are met. Residents are treated with respect and care is delivered in privacy. EVIDENCE: New care plans are being introduced for all residents and the manager said that she hoped to have them all in place by the end of August. A sample of the new care plan was seen in use for a new resident and this was of a good standard. At the time of the inspection several residents were very frail and were cared for in bed. These residents were all clean and appropriately dressed, and pressure relieving equipment was in place. Charts were in place to record care given. These demonstrated that fluids were given and that the residents were regularly re-positioned. The charts showed that there was usually a four hour period in the morning between approximately 7:30am and 11:30am when these residents did not have a drink. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 11 The manager said that she would ensure that a member of staff was assigned to giving these people a mid-morning drink. This was particularly important at the time of the inspection as the weather was very hot. The manager said that four residents had pressure sores. Two of these were very superficial in nature and the other two were due to the residents having severe circulation problems. Care plans demonstrated that appropriate wound care was being given, with advice sought from the tissue viability nurse when needed. All residents with continence difficulties have been assessed recently by the continence advisor and are receiving appropriate aids. These are kept in each person’s bedroom. Additional moving and handling equipment has been provided however the area manager considered that some members of staff required further training in order to use the equipment effectively. The nursing homes doctor visits Kingscourt weekly. Care plans recorded that residents had been referred to a dentist, chiropodist, optician, speech and language therapist and dietician as needed. Observation during the inspection showed that residents were treated with dignity and that their privacy was respected when personal care was being given. The home is changing to a monitored dosage system of medicine management on July 18th and new drug trolleys were delivered during the inspection. Training will be provided for all of the nurses. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Social stimulation for residents needs to be improved. Visitors are made welcome at the home. A good standard of catering is provided. EVIDENCE: Residents enjoy a game of bingo and a reminiscence session sometimes, and a musical entertainer visits periodically; however there is no regular plan of social activities. A member of staff has been appointed as activities organiser and the area manager said that she will receive training within the company to enable her to fulfil the role. A residents’ meeting was due to be held later in the week to discuss what activities residents would like to be provided. The home has access to a minibus that is shared with another service. On the day of the inspection six frail residents were cared for in bed. The area manager said that there had been several more residents cared for in bed but they had been reviewed and had been encouraged and enabled to come out of their bedrooms so that they could enjoy a better quality of life. None of the residents who were in bed had a television, radio or music playing. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 13 The care plan relating to one of these residents said that she appeared to enjoy watching TV. Their bedroom doors were closed. Some bedrooms were extremely warm but fans were not in use. The area manager expressed her concern about the potential isolation of these residents. She agreed that it may be possible for more people to spend time out of bed if suitable supporting chairs were provided. They would also be able to have their bedroom doors open and see people passing if fire guards were fitted to their doors. See requirement and recommendation. Two visitors were spoken with and they confirmed that they are welcomed at the home at any time. One of the visitors, who was the wife of a resident, said that when she had been ill recently, and unable to visit, the manager had telephoned her several times and she and her husband had appreciated this very much. Residents have three full meals a day. Breakfast is provided whenever residents are ready. Some people have breakfast in their bedroom and some come to the dining room. Lunch is a three course meal and a choice is available for each course. Most residents have their lunch in the dining room and enjoy sitting having a conversation with others. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Complaints are dealt with appropriately. Staff should receive training to raise their awareness of Adult Protection and Whistleblowing. EVIDENCE: The home has a complaints procedure. Complaints records were inspected and provided evidence that the manager dealt appropriately with any complaints received and action was taken as needed. The manager and the area manager considered that staff had felt reluctant to report poor practice. They said that this was now improving, however additional training could be provided to increase their awareness of their responsibility to report any concerns. See recommendation. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 25 and 26. A number of bedrooms and communal areas are in need of improvement. The home does not have chairs suitable to meet the needs of more frail residents. The nurse call system needs to be improved. Hot water temperatures are not satisfactorily controlled in all bathrooms. Records were not available to show whether Legionella testing had been carried out. The home is clean with no unpleasant odours. EVIDENCE: A tour of the home showed that the environment had not been well maintained over recent years. Paintwork is knocked and marked in communal areas. Four bedrooms have been re-decorated and carpeted but the wash basins have not replaced. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 16 Some bedrooms are in a poor condition with stained carpets, shabby furniture and wash basins that are marked and cracked. A programme of refurbishment for these rooms, with time-scales, needs to be produced. See requirement. The ground floor bathroom has a very low ceiling and the lighting is poor. See recommendation. The outdoor sitting area for residents has been improved. Following the change of ownership of the home, a copy of the last inspection report from the Fire Officer had not been found. A copy of this needs to be obtained to ensure that the home is complying with any requirements made. See requirement. The range of chairs available does not meet the needs of all residents. An assessment should be carried out by a suitably qualified person to ensure that suitable comfortable seating is provided for frail people who require additional support. See requirement. A nurse call system is installed in all resident areas however a member of staff pointed out to the inspector that the system has only one point where the alarm rings, therefore it can only be heard by a member of staff who is working in this area. Fortunately this is situated near to the manager’s office and the main lounge, but staff working on the first and second floors of the home are not aware that a resident is calling for assistance. See recommendation. There have been major difficulties with the home’s water systems, and at the time of the inspection hot water temperatures could not be adequately controlled within safe limits in all bathrooms. See requirement. There were no records available to demonstrate whether water systems had been tested for Legionella. See requirement. At the time of the inspection only two housekeepers were employed at the home. Recruitment was ongoing. All areas inspected were found to be clean. Laundry staff are employed and new laundry machines had been installed. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. The home provides an appropriate number and skill mix of staff to meet the needs of residents. Appropriate recruitment practices are followed to protect residents. Training is provided for all staff. EVIDENCE: At the time of the inspection, staff recruitment was taking place and staffing levels were maintained with support from agency staff. Shift patterns have been reviewed and the practice of nursing staff working 14 hour shifts has been discontinued. More nurses have been recruited and the skill mix of staff has been improved. A problem of absenteeism, particularly at the weekend, was being monitored. Good recruitment procedures were seen to be in place and the required checks were carried out for all new staff. A company trainer is visiting the home on a weekly basis and is providing a programme of training for all grades of staff. Care staff all have the opportunity to enrol for NVQ qualification. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38. The home has an experienced manager who has a nursing qualification and is working towards a management qualification. Records were not available to show that all health and safety checks had been carried out. EVIDENCE: The home has a new manager who is a registered nurse and has management experience. She has been previously registered with the Commission for Social Care Inspection. A high level of support is being provided by the area manager during the transition period. A deputy manager is being recruited. Following the change of ownership of the home, not all maintenance and servicing records were available. Missing records included the gas safety certificate and the electrical wiring certificate. See requirement. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 19 Accidents and incidents were well recorded. The company trainer was providing training for all staff relating to health and safety topics. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 x x 2 x x 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x x x 2 Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 21 No 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 OP19 Regulation 23 Requirement The registered person must provide a programme of refurbishment, with identified timescales, for all of the bedrooms that are in a poor condition Comfortable seating must be available to suit the needs of all residents. The home must comply with any requirements made by the Fire Officer. Residents must be protected from Legionella infection. Residents must be protected from the risk of scalding by hot water. The registered person must provide evidence that all systems of the home are maintained in a safe condition. Timescale for action 1/10/05 2. 3. 4. 5. 6. OP12 and OP22 OP19 OP25 OP25 OP38 23 23 13 13 13 31/10/05 31/10/05 31/10/05 31/10/05 31/10/05 Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 22 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. 2. 3. 4. Refer to Standard OP12 OP18 OP22 OP22 Good Practice Recommendations Consideration should be given to the social needs of residents who are cared for in their bedrooms. Staff should receive training regarding whistleblowing. Lighting in the ground floor bathroom should be improved. The nurse call system should be improved. Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT 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 Kingscourt Nursing Home F51 F01 S18722 Kingscourt V229090 130705 Stage 4.doc Version 1.30 Page 24 - 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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