Inspection on 08/06/05 for Kingsleigh House

This inspection was carried out on 8th June 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

Kingsleigh House 14/10/09

Kingsleigh House 29/06/07

Kingsleigh House 02/11/05

Kingsleigh House 29/11/04

Similar services:

Westmead

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

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

CARE HOMES FOR OLDER PEOPLE KINGSLEIGH HOUSE 37 Harbinger Road Kings Norton Birmingham B38 OAD Lead Inspector Rachel McGorman FINAL - Unannounced 8 June 2005 - 10:00 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. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kingsleigh House Address 37 Harbinger Road Kings Norton Birmingham B38 OAD 0121 459 9995 0121 451 2868 admin@cch-uk.com Bethany Guild (Christadelphian Homes) 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) Mrs Pauline Bateman CRH 30 Dementia 0 over 65 Old age Physical disability - over 65 30 30 30 Category(ies) of DE(E) registration, with number OP of places PD(E) KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Additional registration has been granted for two named persons under the age of 65 years, one with a physical disability and one with a learning disability. Date of last inspection 29 November 2004 Brief Description of the Service: Kingsleigh House is registered to provide residential care for up to 30 older people of the Christadelphian faith who are active, who may have a physical disability or who may experience mental health problems. The home may also accommodate 2 named persons under the age of 65 years, one with a physical disability and one with a learning disability. Respite care can be provided when a room is available. A day care facility can also be made available. Kingsleigh House is owned and run by Christadelphian Care Homes, (formerly Bethany Guild which was formed in 1943), and is a registered charity. The home is administered by a Board of Trustees, with the assistance of an Administrator and the local Home Committee. Situated on the borders of Worcestershire and on the edge of Birmingham, Kingsleigh House is a purpose built 2 storey building which also incorporates a sheltered housing unit for more independent older people. The stated aim of Kingsleigh House is to provide care and support in warm and friendly surroundings where service users, relieved of the many pressures of life, can enjoy the company of those who share their faith, hopes and values. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this routine, unannounced inspection was to follow up previous requirements and recommendations, and to monitor the care provision in relation to the stated aims and objectives of the home. The inspection took approximately 5 hours, and about half of the time was spent talking with service users and staff, in order to ascertain their respective views on living or working at Kingsleigh House. Several parts of the building were seen, including the areas where upgrading work was being done. The care records of the residents interviewed were seen, and also the records of three members of staff. In addition, the records kept in respect of the maintenance of equipment and safe working practices were inspected. What the service does well: Comprehensive information is available to prospective residents, their families and interested parties, about the home, and what can be provided. A friendly, welcoming atmosphere is immediately evident, and a high standard of care is maintained, which is very much appreciated by service users. Staff know they are valued, their views are taken into consideration, and training opportunities are provided, to ensure they have the knowledge and skills to deliver appropriate care for residents. Recruitment procedures are thorough, and recording procedures are maintained to a high standard, and confirm the good organisational ability of senior staff at the home. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 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. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 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 standard(s) 1,2,3, & 5 Relevant information is available to prospective service users, to enable an informed decision to be made about their future care. All service users belong to the Christadelphian Community, and have chosen to live in the home because of their personal beliefs. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 9 EVIDENCE: The Statement of Purpose and the Service Users Guide provide prospective residents and their family, with the information needed to make a decision with regard to their future care needs. Further details about the home are included in Guidance Notes for Residents. A statement of the terms and conditions of residence is also provided to each resident on admission to the home. A satisfactory admissions procedure is followed by staff at Kingsleigh House, A detailed assessment of need is undertaken, prior to a service user being admitted to the home, and this information is used as the basis of the initial care plan following admission. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.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, 9 & 11 The individual plan of care for each resident is maintained to a satisfactory standard and contains relevant information, which ensures that the health and personal care needs of service users are met appropriately. Arrangements for the safe administration of medication were in place. The advice of the Pharmacist Inspector had been sought, and a detailed policy and procedure implemented. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 11 EVIDENCE: A care plan based on the initial assessment is produced for each service user and is reviewed regularly, with amendments made depending on the changing needs of the individual. The home is well supported by the primary health care teams. A weekly visit is made by the GP, with an additional visit when requested. The District Nurse and Community Psychiatric Nurse can be approached for advice if necessary. The requirements following a recent visit to the home by the Pharmacist Inspector, have all been met, and a satisfactory medication policy is now in place. A copy has been submitted to the Commission. A new medication trolley has also been provided. Bereavement training has been provided for staff. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.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) 12,13,14 & 15 Links with the community are maintained, and ensure that the lifestyle of service users meets their religious interests and matches their expectations. Nutritious and wholesome food was provided for residents, with seasonal variations, and individual wishes and needs were catered for. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 13 EVIDENCE: Service users are able to choose how they wish to spend their time and some like to stay quietly in their room, whilst others prefer to be more involved. Various activities are arranged both within and outside the home, and are organised by a committee. They include the following: • Music and movement sessions • Going shopping • Hymn singing • Knitting group • Social events • Reading group The commitment of service users at the home to the Christadelphian faith gives a sense of common purpose and belonging. The periods of Bible Study and Worship are said to be a very important aspect of daily life and a Bible reading is usually held each evening. Service users are also able to attend the local church situated in the grounds of the home. A four weekly menu is produced at the home, is varied and provides a balanced diet. Special requirements can be catered for, and currently there are several diabetic diets provided. Assistance is given with eating whenever necessary. Service users all expressed satisfaction with the standard of the food, and confirmed that they were consulted about their preferences by the catering staff. There is a recognition by the management that the community atmosphere could detract from service users individual freedom of choice, although evidence that service users lived at Kingsleigh House because that was their wish, was confirmed during discussions with individual service users. The following are some of the comments made: • We are very blessed living here • The food is lovely • It’s not home, but it’s as good as it can be • Everyone is very nice KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.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) 16,17 & 18 The home has a satisfactory complaints procedure, and service users confirmed that their views are responded to appropriately. An awareness by staff of the issues relating to abuse, and the protection of vulnerable adults, has resulted in the development of an open culture within the home. EVIDENCE: A complaints procedure has been produced, and contains relevant information. A copy has been provided to each service user, and all concerns are dealt with immediately. The records indicated that one complaint received recently, has been resolved to the satisfaction of the resident. The policy of the home acknowledges the rights of service users in every respect, and they are enabled to access medical, legal, advocacy and civic services depending on the needs and wishes of the individual. Policies and procedures relating to the protection of service users from abuse are in place, and staff demonstrated an understanding of the issues relating to the many forms of abuse. Documentation in respect of the Protection of Vulnerable Adults has been produced by the organisation, and a copy submitted to the Commission. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 15 KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 16 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, 20, 21, 22,23 & 26 The standard of cleanliness is excellent, the décor and furnishings are in good condition and the building is well maintained throughout, providing a very comfortable and homely environment for residents. The needs of residents are met in relation to the environment in which they live, and their safety and wellbeing is assured as far as possible at Kingsleigh House. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 17 EVIDENCE: Kingsleigh House is situated in an urban area and is a purpose built, two storey building providing comfortable and well maintained accommodation. A sheltered housing provision is available on site, although several of the flats have been incorporated into the home and now provide a residential facility. They can be used as single accommodation, or for married couples when a sitting room and a bedroom can be made available. There is a rolling programme of redecoration, and further proposals for improving the facilities for residents were discussed during the inspection A planned development of some parts of the building is currently being undertaken, including the kitchen, which has been completely refurbished to a high standard. A satisfactory report has been received from the Environmental Health Officer. There is a large lounge and dining area which, together with a pleasant all weather conservatory provides adequate communal space within the home. Bathing, washing and toileting arrangements are satisfactory. All the bedrooms in the main part of the home are for single occupancy, and have en suite facilities. Aids and adaptations are specifically provided to meet the needs of individual service users. Regular checks of equipment are undertaken and contracts are in place for servicing of the shaft lift, bathroom hoists and other essential services. The high standard of cleanliness and consistently pleasant atmosphere throughout the home were commendable. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 18 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, 28, 29 & 30 The home is adequately staffed with employees who are experienced and competent to care for older people. Training opportunities are provided for all staff, who demonstrate a clear understanding of their roles and responsibilities. The morale of staff is good, and they benefit from being part of a cohesive team, which enables them to consistently provide a good standard of care. Recruitment and selection procedures are detailed and thorough, and help to ensure the protection of residents. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 19 EVIDENCE: Staffing levels at the home are maintained to a satisfactory standard. The staffing situation is stable at present, and recruitment problems have eased. The recruitment policy and procedure has been reviewed and a copy submitted to the Commission. The requirements of the National Minimum Standards, with regard to NVQ Level 2 training, have been achieved at the home, which represents a high level of commitment from both the management and staff. 11 staff achieved the Level 2 in Care, and 3 have attained Level 3. In addition 2 staff have completed the Assessors Award. A satisfactory recruitment and selection procedure is followed, with both verbal and written references being obtained, and a review of the process has been undertaken recently. A training programme has been implemented, and covers food hygiene, fire awareness, first aid, health and safety and moving and handling. Care related training has been provided on dementia, diabetes, infection control, bereavement, and abuse awareness. All staff with responsibility for administering medication have appropriate training, and senior staff have undertaken the Full First Aid at Work Course. Induction and Foundation Training to the NTO specification is being implemented, and is incorporated with the NVQ Level 2 training. Comments from staff about their experiences of working at Kingsleigh House were all very positive, and they confirmed that it was a happy home. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 20 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, 32, 33, 36, 37 & 38. The management arrangements at the home are satisfactory. The Registered Manager is very experienced, and qualified both in management and care, and residents and staff benefit from the positive approach and leadership they receive. Supervision procedures provided relevant support to staff. Effective quality monitoring systems are in place, and the views of residents, their relatives, staff and other interested parties are regularly sought, which enables their involvement in the way in which the home is run. The health, safety and welfare of residents and staff is promoted at the home, and procedures are in place to ensure that they are protected in respect of all safe working practices. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 21 EVIDENCE: The registered manager has many years experience in the care of older people, and is extremely competent in her role. Mrs Paula Bateman has taken the Advanced Management for Care Course and has the Diploma in Management of Care Services. She has also achieved NVQ Level 4 and the Registered Managers Award. The senior management team at the home create an open and positive atmosphere. Daily briefing meetings are held with carers to ensure good communication, and regular staff meetings are also arranged. A weekly management meeting also takes place to review and plan the day-to-day administration and delivery of care. A formal quality assurance system had been developed by the Organisation, and the views of service users and their families are regularly sought. Informal monitoring is also undertaken through the involvement of the many people in regular contact with Kingsleigh House, including groups from other homes, relatives, friends and members of the local church. A formal programme for the supervision and appraisal of care staff had been introduced. A review of the recording procedures has been undertaken recently, and the records seen were completed to a satisfactory standard. A Health & Safety Policy has been produced at Kingsleigh House, and contracts were in place for the regular maintenance and servicing of equipment within the home. Risk assessments have been reviewed and updated. Training for staff in relation to all safe working practices has been organised. KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 22 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 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 x x 4 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 Standard No 16 17 18 Score 3 3 3 4 3 3 x x 3 3 3 KINGSLEIGH HOUSE E52 S18461 Kingsleigh House V226151 080605.doc Version 1.30 Page 23 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 Regulation Requirement There are no requirements following this inspection 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. Refer to Standard 7 12 29 Good Practice Recommendations Consideration should be given to further development of the care planning process. The possibility of providing additional activities for service users should be explored. A review of the recruitment procedures should be undertaken, specifically in relation to the content of the staff files. 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