Inspection on 01/03/06 for Kingsley House Nursing Home

This inspection was carried out on 1st March 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

Kingsley House Nursing Home 09/10/06

Kingsley House Nursing Home 30/08/05

Kingsley House Nursing Home 30/03/05

Kingsley House Nursing Home 18/11/04

Kingsley House Nursing Home 30/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Kingsley House Nursing Home Gumstool Hill Tetbury Glos GL8 8DG Lead Inspector Mrs Janet Griffiths Unannounced Inspection 10:00 1st March 2006 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 Kingsley House Nursing Home DS0000016486.V284758.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. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kingsley House Nursing Home Address Gumstool Hill Tetbury Glos GL8 8DG 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) 01666 503333 01666 503318 The Cotswold Nursing Home Company Limited Mrs Barbara Jean Harpwood Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2005 Brief Description of the Service: Kingsley House is a care home providing nursing care for thirty-three older people. The property is an historic eighteenth century building, which has been converted and adapted for its current purpose. Service users accommodation is provided on four floors, all of which are accessible by stairs and shaft lifts. A large number of residents are accommodated in shared rooms, with thirteen single rooms available. Some rooms provide en-suite facilities, or there are communal bathrooms that provide assisted bathing facilities and toilet facilities conveniently situated around the home. Each room has its own wash hand basin. Large lounges are situated on the first and ground floors, and a dining room and conservatory are also on the ground floor. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over four and a half hours on one day in March 2006, by one inspector. The registered manager and proprietor were present during the inspection, which consisted of speaking with residents and their relatives and staff, visiting some rooms and examining staff records and some personal care records. What the service does well: What has improved since the last inspection? What they could do better: Recruitment procedures are still not completely robust and problems with the Umbrella Body carrying out CRB checks must be addressed. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 6 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. Kingsley House Nursing Home DS0000016486.V284758.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 Kingsley House Nursing Home DS0000016486.V284758.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): 3 The admission process is well managed and residents are given clear information regarding the service. EVIDENCE: Three residents who had been admitted since the last inspection were spoken with. Two relatives were also seen. One gentleman said that he had not visited prior to admission but his nephew had and ‘it came recommended’. He had also had another relative who had stayed in the home. He was very happy having made the decision not to live alone any longer. His room was quite small but satisfactory and he had been told that if another room became vacant he could move if her wished. The second had been admitted for respite care as an emergency. Her relatives who were spoken with said they had already viewed likely homes and ‘liked this one the best because of its friendly atmosphere’. The manager had visited the service user prior to admission to carry out an assessment. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 9 The relatives were very appreciative of her assistance at this time as they live in Scotland and said that the manager had kept in touch with them and kept them informed of the situation. The resident was enjoying her lunch during the visit so was not interrupted other than to say that she was enjoying her lunch and had settled in ‘but it was not like home’. Her family said she preferred to remain in her room rather than join the other residents but staff made regular contact with her and they were happy with the room she had overlooking the town. The third resident was very frail and being nursed in bed. She stated that ‘she was ready to die’ apparently a common phrase that she uses but said that the staff were very good. She was in a shared room but reportedly has quite a good relationship with her companion, ‘they watch out for each other’. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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): 7,10,11 Residents are well looked after in respect of their health and personal care needs. Their privacy and dignity is respected. Residents are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: Care records of three residents were examined in detail. All had assessments completed and from these relevant care plans were made and showed evidence of regular review, though not as yet in partnership with the resident or their representative. Risk assessments are completed for pressure sores, moving and handling and general risk assessments. Night care plans are also completed. The records examined were clear and well maintained and reflected the current needs of the residents. All also confirmed input from other professional agencies such as the continence adviser, the audiologist, the optician and all had doctor’s visits as required. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 11 The home has a number of shared rooms, but the privacy of the residents is maintained when personal care is carried out, personal possessions are clearly identified and each resident has their own personal storage space. Everyone is asked on admission whether they wish to share or not and if a shared room was the only one available for a prospective resident who did not wish to share then they would be given the choice to look for alternative accommodation. The residents of only one shared room were seen on this occasion and the arrangement appeared to work well for them. One other resident spoken with was in a shared room but was the only occupant at present. Over recent months a group of staff at the home have taken part in a pilot programme called ‘the end of life initiative’, run by the Avon, Gloucestershire and Wiltshire strategic health authority. The aim is to offer all adults in the home, nearing the end of their life the same high quality palliative care, enabling them to chose where they wish to die, for example in the home or transferred to hospital. The group attended monthly mentorship sessions (one of which the inspector joined them) and from these and the training sessions they attended, a number of very worthwhile initiatives have been introduced to the home to include emotional care plans, arrangements for death and dying and an end of life care plan. The latter would involve everyone directly involved to include the resident, their family and their doctor. One action plan that the group developed was to hold a thanksgiving and celebration service followed by a tea, in memory of all the residents who had died over the past year. The first was held on 6/2/06. Invitations were sent out to bereaved relatives and following a short service conducted by local church ministers, staff spoke a little about their memories of each resident and balloons were let off in the garden, one for each resident. The occasion was marked with photographs and was very successful and much appreciated by both families and staff. The home now plans to make this an annual thanksgiving celebration. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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): 13,14,15 Families are encouraged to be involved in residents’ lives at the home and links with the community are maintained. Residents are able to exercise choice and control over their lives. Appetising and wholesome meals are provided in pleasant surroundings. EVIDENCE: Visitors are welcomed to the home and on each occasion the inspector has been at the home there has been a steady stream of visitors who appear to have a good rapport with the staff. The two visitors spoken with on this occasion were more than satisfied with the home and its friendly atmosphere although they had one or two comments regarding communications, cleanliness and access to the call bell, which were fed-back to the manager. The home continues to fundraise through raffles and teas in order to arrange regular trips out for those residents who wish to go. Monthly communion and songs of praise continue as do a variety of other activities that residents may choose to participate in of they wish. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 13 Those spoken with also confirmed that they also have the choice of how and where they spend their days with some preferring to remain in their rooms to read, watch television or listen to music whilst others enjoy sitting together in one of the lounges and meeting for lunch. A new chef has been appointed since the last inspection and a varied and appetising menu has been planned. Everyone spoken with praised the quality and quantity of the food provided. One gentleman related how they had pancakes the previous day (Shrove Tuesday). He could not remember the last time he had had pancakes and ‘they were so good he had two’. Lunch on the day of the inspection looked and smelt very appetising and residents observed were eating well and cleared their plates. At least three vegetables are offered with each lunchtime meal. Homemade cake is offered each afternoon as well as fresh fruit salad for those who would like it and homemade soup and light meals and snacks provided for the evening meal. Snacks are always available on request throughout the night but as one said ‘we are so well fed, I don’t need anything after tea’. Soft and pureed diets were also seen and were well presented and assistance was being offered in a discreet manner. The kitchen was not inspected on this occasion as the Environmental Health Officer did an inspection the previous week, but work was ongoing in the food storage areas. The chef was informed that it is a requirement to keep a record of all the food provided each day, specifying vegetables used and choices of sandwiches. He commenced this at once. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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): EVIDENCE: None of the standards in this section were inspected on this occasion. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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): EVIDENCE: None of the standards in this section were inspected on this occasion but the home was clean and well maintained and some redecoration had been completed since the last inspection to include the main corridor. One room requiring redecoration at the last inspection had not yet been addressed as the resident remains in the room all the time and the staff did not wish to disturb them. It was reported that since the last inspection the roof had been repaired which was a major job and a new lighting system to provide much better lighting, is about to be installed. Work on the plumbing and heating systems is also planned. There are plans for extension in the near future to create at least a further three bedrooms. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 16 Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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): 27,28,29,30 Staff at the home are well trained and supported and employed in sufficient numbers to meet the residents needs. The procedures for the recruitment of staff need to be more robust to provide safeguards and offer protection to people living in the home. EVIDENCE: The manager, an adaptation student working under supervision, and six care staff were on during the day of inspection. The staffing levels appeared to be adequate to meet the needs of the residents, who also confirmed that their needs were met. One relative did comment on the standard of cleaning on one occasion but had had no further cause for concern. He also mentioned the inaccessibility of his mother’s call bell, but qualified this by saying that she probably wouldn’t know how to use it if she had it close by. In addition to care staff two housekeepers, a laundry assistant and a chef and kitchen assistant were on-duty. Records of all newly appointed staff were checked during the inspection. Most of these were from overseas and because most are adaptation students none had complete staff records in place. The provider was spoken with about this and will ensure that completed application forms, copies of references and a health declaration are included in the records of each one. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 18 The home has also been having difficulties with the Umbrella Body who arranges for new staff CRB and POVA checks. Applications were made promptly by the home but no POVA first checks were done before staff commenced at the home and no CRB disclosures were sent to the home for their reference. Some files had copies of previous CRB’s, which are not transferable and must not be photocopied because of the Data Protection Act 1998. It was felt by the home that because the adaptation students had been thoroughly checked before being allowed into he country by the Home Office and then were checked by the NMC for an adaptation programme that this was sufficient. They are also working under supervision at all times as part of the adaptation programme and will not be employed by the home after completion. However, all staff must have all the relevant documentation and preemployment checks if they are involved in the care of the residents in the home. The home continues to train adaptation students linking with a university that audits them regularly for their suitability. They are able to take six students in total. Training records were not looked at on this occasion but it was reported that all the staff with the exception of one carer on night-duty, had either completed NVQ 2 or were currently doing the training. One is waiting to commence. The home is very committed to staff training and development and recent training included moving and handling updates; Protection of Vulnerable Adults; Fire training, infection control and health and safety. First-aid training updates were to be arranged and food hygiene training was imminent. In addition to this clinical training has included wound care, continence and eye care and one member of staff is due to attend dementia training shortly. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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): 31,33,35,38 The Registered Manager/Provider has a supportive, open approach to running the home, which benefits the service users, staff and relatives. Quality assurance programmes have been introduced to ensure that the residents and their relative views are regularly sought and seriously considered when making decisions about the home. The home has minimal input into residents’ financial interests but where they do the residents’ interests are protected. So far as is reasonably practicable the health, safety and welfare of service users, staff and visitors are protected although one risk was identified and needs to be addressed. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 20 EVIDENCE: The manager has worked at the home for a number of years and became manager following the retirement of the previous owner/manager. She has completed the registered managers’ award. Since the last inspection a satisfaction survey was sent to each resident/ their representative and a good response was received. These were seen at inspection but have not been collated as yet. A report is to be published and an action plan devised where any shortfalls have been identified. This programme is to be repeated annually and possibly extended to include professional visitors to the home and staff surveys. Although the proprietor visits the home at least twice a week, as he is not involved in the day to day running of the home, he should be carrying out unannounced monthly Regulation 26 visits and submitting monthly reports of these visits to the CSCI. The CSCI has received one such report since the last inspection. These must be completed monthly. It will be is expected that record keeping and medication audits will also be undertaken by senior staff as part of the staff supervision and training and development programme, as this is very much a learning environment. The home does not act as appointee for any residents’ pensions. Residents or their families generally take responsibility for their finances. In a few cases the home holds small amounts of personal money at the request of a resident or their family and a record and receipts are kept of any financial transaction undertaken. Standard 38 was not inspected fully on this occasion but the requirement from the last inspection was checked and records seen. However it was noticed that one window in a first floor room was not sufficiently restricted and could be a potential risk. It is recommended by the Health and Safety executive that restrictors should allow a maximum opening of 100 mm. Any larger opening should be justified by a risk assessment. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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 2 8 X 9 X 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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 OP7 Regulation 15 Requirement Timescale for action 01/04/06 2. OP29 19 3. OP33 26 4. OP33 24 Review the care plan regularly with the service user or their representative where appropriate and unless it is impracticable to do so. The registered person shall not 01/04/06 employ a person to work at the care home unless the person is fit to work at the home and the registered person has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2 (Timescale of 30/09/05 not met in full). The Registered Provider must 01/04/06 send to the Commission, a monthly report under the criteria of Regulation 26 (Timescale of 30/10/05 not met in full). Ensure that a quality assurance 01/06/06 and monitoring programme is in place and maintained for reviewing at appropriate intervals and improving the quality of care provided at the home Timescale of 28/02/06 not met in full). Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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. Refer to Standard OP38 Good Practice Recommendations Ensure provision and maintenance of window restrictors is in place based on an assessment of vulnerability of and risk to service users. Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Kingsley House Nursing Home DS0000016486.V284758.R01.S.doc Version 5.1 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!