Inspection on 20/07/06 for Kingscourt Nursing Home

This inspection was carried out on 20th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kingscourt Nursing Home 15/05/07

Kingscourt Nursing Home 13/12/05

Kingscourt Nursing Home 13/07/05

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 Cheshire CH2 3RB Lead Inspector Wendy Smith Key Unannounced Inspection 20th July 2006 9:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kingscourt Nursing Home DS0000018722.V299588.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. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingscourt Nursing Home Address 12 Newton Lane Hoole Chester Cheshire CH2 3RB 01244 313201 01244 350133 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) Springcare (Kingscourt) Limited Lindsey Elizabeth Unsworth Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home is registered for a maximum of 37 service users in the category OP (Old age, not falling within any other category) 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 13th December 2005 Date of last inspection Brief Description of the Service: Kingscourt Nursing Home is a purpose built three storey 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 and 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 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. The current weekly fees are from £390 to £410. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process for Kingscourt included a site visit to the home on 20th July 2006 which was unannounced and was completed in one day. The home had 32 residents, 25 of whom were receiving nursing care. Time was spent talking with the manager, staff and residents, and observing the day-to-day routines of the home and care staff as they provided support. The building was looked at to assess its suitability to provide a comfortable, homely environment for the enjoyment of residents and to ensure their safety. A sample of care plans and other records was looked at and a pharmacist inspector reviewed the arrangements for medicines. Before the visit, comments cards were sent to residents and relatives, and the eight residents who completed a questionnaire made positive comments. Comments cards were also been sent to GPs and other professionals who visit the home. The home manager completed a pre-inspection questionnaire. The home promotes equality by treating people as individuals and ensuring that diversity needs such as impaired mobility and gender are appropriately met. People who use the service confirmed that care staff are kind, caring and responsive to meeting individual’s needs. What the service does well: The health and personal care needs of residents are met and are recorded in their care plans. Relatives are made welcome and are involved in the care. Social activities, including weekly trips out, are provided. Residents expressed their satisfaction with the meals. Any complaints are investigated in full and responded to appropriately. Agreed staffing levels are maintained and robust recruitment procedures are followed for the protection of residents. Training is provided for all grades of staff. The home has a competent and experienced manager who staff, residents and visitors find approachable. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents can be met at Kingscourt. Intermediate care is not provided. EVIDENCE: Over the last year 14 new residents have been admitted to the home. All of the residents who completed a questionnaire stated that they had received adequate information about the home before admission and that they had a contract. A new brochure is being printed. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 9 The manager said that she visits all prospective residents before admission is arranged. A pre-admission assessment is completed and is kept in the resident’s care plan for first month and then filed. The home also receives a social services assessment. One resident has a long standing mental illness and a number of other residents have some degree of confusion and/or memory loss, however there was evidence that these residents also had care needs due to physical frailty. The home receives support from mental health services in meeting the needs of some of these residents. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health needs of residents are met and are recorded in their care plans, but the medication processes continue to be unsatisfactory. EVIDENCE: A sample of four care plans was looked at. The care plans are lengthy and not easy to follow but they were mainly up to date and well completed. The care plans contained a full assessment of the residents’ needs and recorded visits by GPs, diabetic nurse, chiropodist, optician, social worker. All of the care plans looked at recorded the resident’s wishes in the event of serious illness or death Three frail residents were being cared for in bed. The daughter of one of these residents was assisting her with her meal. She said that she was very satisfied with the care provided to her mother, but that if she had any concerns she would not hesitate to take her concerns to the home manager. Charts were in the bedrooms to record the care given to these residents throughout the day and night. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 11 One resident has very poor circulation in her leg resulting in tissue breakdown. The care and treatment provided was recorded in her care plan. Adjustable beds and pressure relieving mattresses are available for residents who need them. A resident spoken with in her bedroom appeared to be extremely underweight. Her care plan showed that her condition was being monitored and that appropriate professionals were consulted to advise about her care. A visiting district nurse was spoken with. She said that she is always able to find staff to speak with and residents always appear to be well cared for. Comments card received from two GPs who visit the home indicated all positive responses. A CSCI pharmacist inspected the medicines because the lead inspector had been concerned that some improvement was needed. The home has procedures for handling and recording medicines for staff to follow to give medicines safely. This was not being done properly. Some doses of tablets had been signed as given but the dose remained in the pack. There were many instances where the doses had gone from the pack but it was not possible to be sure that they had been given, as the records had not been done. Some medicines were not being recorded as given according to the directions on the label and there were records of residents not having their medicines but the reasons why were not recorded. The pharmacist spoke to a resident who used her own inhaler and kept it by her in her room. She said that she was well looked after and that staff brought her other medicines to her room because she had problems getting about. She was always awake early when the night staff brought her inhaler solution in the morning. Medicines were stored securely and controlled drugs managed properly. Some medicines that do not keep for long after opening were not marked with the date opened to be sure they were fit to use. These shortfalls were discussed with the home manager who expressed her disappointment. She said that she will carry out a daily audit of the medicines for the next month and if necessary take disciplinary action if any of the nurses do not comply with the required standard of administration and recording. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social needs of residents are catered for and a good standard of meals is provided. EVIDENCE: Most residents spend their day in the lounge, but some prefer to stay in their own room. Unfortunately the lounge is a very large and open room which makes it very difficult to have a private conversation. The manager said that the development plan for the home includes the division of the lounge into smaller sitting areas. Residents are given the choice to have breakfast in their bedroom and this has reduced the rush for residents to get up and dressed in a morning. However residents can also choose to go the dining room for breakfast. A resident spoken with in his bedroom said that he is very happy at Kingscourt. The food is excellent and he enjoys trips out on the minibus. Another resident spoken with in her room was very complementary about the meals and felt that she was well looked after. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 13 The home employs an activities organiser for 26 hours a week. The activities organiser said that she had been a care assistant at Kingscourt for 16 years and knows all residents well. Each week she provides some group activities and a trip out in the minibus every Wednesday. She also spends one to one time with residents and takes some residents out shopping. She has an allocated budget for activities but also fundraises. The activities organiser keeps a record of what events have taken place in a diary. She is hoping to take part in the Primary Care Trust’s forum for activities organisers working in care homes. The standard of meals provided is consistently good and residents confirmed this. The pureed food for residents who have swallowing difficulties was nicely presented. Both of the cooks have worked at the home for a considerable length of time. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 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 the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are responded to in full by the home manager. EVIDENCE: Six complaints have been recorded during the last year, but none so far in 2006. The complaints records showed that all of these complaints were thoroughly investigated by the home manager and responded to in writing. The manager has attended Protection of Vulnerable Adults training with Cheshire social services and she is leading training for all staff. Training sessions have been held on 30th June and 18th July 2006 and will continue until all staff have attended. The pre-inspection questionnaire showed that all staff have a satisfactory Criminal Records Bureau disclosure. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 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 the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most areas of the home are now satisfactory but some further improvements are still needed. EVIDENCE: The home changed ownership in 2005 and substantial investment has been made by the new owner to improve the accommodation. About 75 of bedrooms have been refurbished, however there are a small number that remain below standard including some old furniture that has dangerous sharp edges and some poor carpets. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 16 The lounge has some new chairs and a carpet that is in good condition. It looked cleaner and tidier than on previous visits. The manager said that new dining room furniture has been ordered. There was an air cooler in use in the dining room. Unfortunately there are no blinds in the conservatory and it was too hot for anyone to sit in. The garden is small but it has been tidied and has new furniture and provides a pleasant sitting area. Some outside woodwork needs painting. The bathroom on the ground floor is small and has a low ceiling that is oppressive. The manager said that she hopes it can be converted to a shower room. The home has a maintenance person and a housekeeper and the general appearance of the environment is much improved. Residents who completed a questionnaire were satisfied with the cleanliness of the home. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 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 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Nurses, care staff and ancillary staff are provided to meet the needs of residents and training is provided for staff. EVIDENCE: The home employs seven nurses, 20 care staff and 13 ancillary staff. Six care staff have a national vocational qualification in care, and three staff who are employed as carers are overseas nurses. No care staff are working towards NVQ at present. The pre-inspection questionnaire showed that 14 staff have left in last year, including 11 carers. There are two nurses on duty in a morning and afternoon, and in the evening either one or two. Five carers are on duty in a morning, and four in an afternoon and evening. At night there is a nurse and three carers. Agency staff are used to cover any shortfall. The personnel files for the two most recently recruited staff were looked at and they showed that good recruitment practices had been followed. Another new carer was spoken with and she confirmed that, although she had previous experience in care, she had received induction training before she started to work with residents. The manager said she verifies all references received. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 18 The home has joined a training consortium and nurses have attended courses including chronic heart failure, triage and confirmation of death, tissue viability and infection control. All of the nurses attended record keeping and accountability training. The manager and one of the nurses are able to provide moving and handling training. The week before this visit there had been training sessions for fire safety and continence. A member of staff said that there is a lot more training than previously. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 19 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed to promote continuing improvement of the facilities and services provided. EVIDENCE: A new manager was appointed in 2005. She is a registered nurse with previous management experience and she has been registered with the Commission for Social Care Inspection as manager of this service. Staff, residents and a visitor spoken with described the manager as very approachable and always ready to listen. The manager’s hours are supernumerary to the staffing rota but there is no administration support which means that some of the manager’s time is taken up with routine office duties. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 20 The company that owns the home has quality assurance processes to ensure that the home is run in the best interests of the residents. Unannounced visits, required by regulation 26 of the Care Homes Regulations, are carried out monthly by the area manager. Regular meetings are held for residents, relatives and staff. A weekly progress report to head office includes details of any complaints, accidents and pressure sores. Small amounts of personal spending money are in safekeeping for most residents. Good records of all transactions are kept, and residents’ money is in individual envelopes. This is mainly used for hairdressing, newspapers and small items of shopping. The hairdresser provides individual receipts. One resident is having appointeeship arranged through the local authority. Information received prior to the visit indicated that 28 residents have a Power of Attorney arrangement. Staff receive the required training in health and safety. The home’s maintenance person is also the fire trainer for the company. He carries out a series of weekly and monthly health and safety checks which include a weekly fire alarm test, and monthly emergency lighting and extinguisher examination. All smoke detectors were replaced in 2005. The records showed that equipment is tested and serviced regularly but some equipment was due to be tested in March 2006 and had not yet been done. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement The registered person must make arrangements to ensure all medicines are given to the prescribed directions. Timescale for action 20/07/06 2 OP9 13(2) The registered person must 20/07/06 make arrangements to ensure that medicine records are kept to the required standard. The registered person must make arrangements to ensure that staff make sure that medicines are fit for use before giving them to the resident. All staff must receive training relating to the Protection of Vulnerable Adults. 20/07/06 3 OP9 13(2) 4 OP18 13(6) 30/09/06 Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 23 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 OP19 OP19 OP19 OP19 Good Practice Recommendations Implement plans for the improvement of the lounge and the dining room. Improve the ground floor bathroom. Continue with the upgrading of bedrooms. Repaint exterior woodwork as needed. Kingscourt Nursing Home DS0000018722.V299588.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich 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 DS0000018722.V299588.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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