CARE HOMES FOR OLDER PEOPLE
Kingsgate 25 - 27 North Street Sheringham Norfolk NR26 8LW Lead Inspector
Mrs Geraldine Allen Unannounced Inspection 25th January 2006 10:00 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 Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 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. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kingsgate Address 25 - 27 North Street Sheringham Norfolk NR26 8LW 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) 01263 823114 01263 821779 Mr Anthony Churchill Mrs Jennifer Churchill, Mrs Virginia Taylor Mrs Lynn Frost Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th November 2005 Brief Description of the Service: Kingsgate is a care home providing personal care and accommodation for up to 31 older people. Mr A Churchill, Mrs J Churchill and Mrs V Taylor own the care home. The home is located close to the centre of the seaside town of Sheringham, close to shops, pubs and other local amenities. The home consists of a three-storey building with 27 single and 4 double rooms on the ground, first and second floors, serviced by a shaft lift. There are a variety of communal lounges and a large dining hall where other social activities can take place. There is also a paved garden area with seating. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the morning of 25 January 2006. Not all of the National Minimum Standards were inspected on this occasion and, where a standard has been inspected, the complete range of sub elements, as set out in the National Minimum Standards, may not have been assessed. On the day of inspection there were 31 residents living at the home and 1 lady visited the home for day care. No residents were spoken to on this occasion, but many residents were seen in various parts of the home during the inspection. Mrs Frost was present throughout the inspection and both Mr & Mrs Taylor called in to the home during the morning to provide information. This inspection looked at the home’s staff recruitment and training arrangements in detail. It was found that the home has good practices that ensure staff are able to provide very good care to residents. What the service does well: What has improved since the last inspection?
The home has made improvements to the records they keep about the care given to each resident. These records are better written and give more detail about the matters that are important to each person. Some of the records being kept about residents did not fully respect their right to confidentiality. The home has made good improvements to these records so that residents can be sure that confidentiality is now protected. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 6 The home has improved the way it assesses risks to residents and how they are recorded. 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. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 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 Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 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): These standards were not inspected on this occasion. EVIDENCE: Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 9 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 The care needs of each residents are clearly set out in individual care plans. Resident’s health care needs are met appropriately. The home has good medicine procedures in place. Circumstances on the day of inspection had resulted in the procedural guidance not being followed fully. EVIDENCE: A requirement was made at the last inspection regarding the way some care records were kept, resulting in lack of confidentiality. Mrs Frost confirmed that the way records are now kept has been reviewed, ensuring all information kept about residents is treated in confidence. Recommendations were also made at the last inspection and these have been fully met. Care records are now completed in full, including any occasions when a resident may refuse personal or other care. Risk assessment training and guidance has been given and staff are now completing risk assessment and risk reduction records in a timely way. The Commission has received a comment card since the last inspection. This was sent by the visiting General Practitioner and showed that staff refer
Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 10 appropriately to the surgery. Staff understand and follow instruction given by the GP. The GP expressed satisfaction with the care given to patients living at this home. The arrangements for the control, administration and recording of medicines were looked at in detail during this inspection. Storage arrangements, including those for in the event that controlled medicines are used, were satisfactory. The medicine storage cupboard contained large quantities of medicines being held “in stock”. Mrs Frost advised that a planned audit of these medicines was scheduled for that afternoon, when surplus medicines would be recorded and returned to the supplying pharmacist. The returns record book was seen and properly kept. The medication administration record (MAR) was seen as part of this inspection. This showed that, although all medicines had been dispensed for the early morning round, the administration had not been signed on the MAR. This was not in accordance with the procedural guidelines at the home and the reason for this omission was explained. A subsequent telephone conversation with Mrs Taylor confirmed that appropriate action has been taken to resolve this matter and full compliance with the home’s procedures will be assessed at the next inspection. See recommendations. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 11 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): These standards were not inspected on this occasion. EVIDENCE: Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 12 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): These standards were not inspected on this occasion. EVIDENCE: Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 13 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): 26 The communal areas of the home, seen during this inspection, were clean and well maintained. EVIDENCE: On arrival at the home, Mrs Frost was involved in a deep cleaning of the dining room. All other areas seen were clean and tidy. No unpleasant odours were detected. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 14 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): 28, 29 & 30 Staff receive training that safeguards residents. The home has recruitment practices that are not entirely in accordance with best practice. The training provided to staff ensures they are able to provide care that is appropriate to each resident. EVIDENCE: Staff at the home are supported to undertake National Vocational Qualifications (NVQs). At the time of inspection, 4 care staff had achieved NVQ at level 4 with a further member of staff currently studying, 1 had achieved NVQ at level 2 with another 1 studying; and Mrs Taylor was studying NVQ at level 4. Three staff files were looked at in detail. The contents were in accordance with best practice and included application forms, Criminal Records Bureau disclosure, training record and supervision records. It was noted that in 1 staff file only 1 reference had been obtained and in another there was no copy of the record of interview. See recommendations. The home employs some overseas staff and the process of recruitment was discussed. In both cases full documentation was obtained and reference checks were in place from Police, medical and good conduct references from their country of origin. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 15 Staff at this home receive t5raining that is relevant to the needs of the residents. Induction and foundation training records were seen and fully completed, including the questionnaires to assess learning. Certificates of training were seen and included 1st Aid, manual handling, fire safety and adult abuse awareness. Mrs Taylor also described planned training that includes fire safety lecture, food hygiene, further medication training and the training of a manual handling trainer. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 16 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): 35 & 38 The home needs to introduce further safeguards to their practice when handling residents’ personal allowances to ensure residents are protected from financial abuse. The health and safety of residents, staff and visitors to the home are protected by good practice. EVIDENCE: The current practice used by the home in respect of residents’ personal allowances was discussed in some detail. The home looks after the expenditure of personal allowances for 15 residents. The home pays for such items as hairdressing, chiropody and newspapers on behalf of residents as required and periodically sends out accounts to the nominated next of kin or advocate for settlement. Suggestions were made to enhance the practice and these are to be implemented by Mrs Taylor. See recommendations. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 17 Those areas of the home seen were in a good state of repair and well maintained. Confirmation of compliance with Food Safety legislation was received from Environmental Health. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 18 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 X X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement Timescale for action 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 OP9 OP29 OP29 OP35 Good Practice Recommendations It is recommended that the Medication Administration Record is completed at the time medicine is seen to be ingested. It is recommended that 2 written references are obtained in all circumstances as part of the staff recruitment process. Any verbal references should be fully recorded. It is recommended that a written record of interview is kept for all staff recruitment interviews It is recommended that all records referring to expenditure made on behalf of residents’ be kept in detail and cross referred to computer held records. Kingsgate DS0000027278.V280597.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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