Inspection on 30/08/05 for Kingsley House Nursing Home

This inspection was carried out on 30th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Kingsley House Nursing Home 09/10/06

Kingsley House Nursing Home 01/03/06

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 Janet Griffiths Unannounced 30 August 2005 10:00 th 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. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kingsley House Nursing Home Address Gumstool Hill Tetbury Glos GL8 8DG 01666 503333 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) The Cotswold Nursing Home Company Limited Mrs Barbara Harpwood Care Home 33 Category(ies) of Old Age (33) registration, with number of places Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 30/03/05 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 D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5-6 hours on one day in August 2005. Opportunity was taken to tour the premises with the manager, talk to residents and staff and examine records. Most of the residents were seen during the inspection and several were spoken to. Two had visitors who gave their views of the service to the inspector. What the service does well: What has improved since the last inspection? This was the first inspection carried out by this inspector so she is unable to say what has improved. However, the one requirement and recommendation from the last inspection have both been met. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 6 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. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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 Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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) 3 The admission process is well managed and through a full pre-admission assessment, the manager ensures that the home is fully able to meet the needs of each resident. EVIDENCE: There have been a number of new admissions since the last inspection. These were identified by the manager and seen by the inspector. All confirmed that they were satisfied with the care provided and that their needs were being met. All appeared to have settled in well. One gentleman was spoken with during lunch and he related how he shared a room with the gentleman sat next to him at lunch. They got on well together and ‘looked after’ each other, being quite happy to share a room. Another gentleman, seen in his room, also said how he was very happy in the home but preferred to stay in his room. Kingsley House Nursing Home Version 1.40 Page 9 D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc A lady visited said how kind all the staff were and how they were always ready to help. She said that one had planned to take her into the town during the afternoon and two staff came to check that she was all right during the conversation. The manager or her deputy, generally carry out the preadmission assessments with adaptation students, as part of their training and development programme, and records of these visits were seen in the care files examined. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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 The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for administration of medication are good with clear and comprehensive arrangements in place to ensure service users medication needs are met. EVIDENCE: Three care record files were examined during the inspection. All were found to have an assessment of abilities form. This gives a dependency score for each activity of daily living and from this, areas where care plans are required are identified and care is planned. Risk assessments to include pressure sore, moving and handling and night care assessments are also completed. Very detailed and informative social history records were kept on most of the records seen and these give a good insight into the residents past life and interests. Regular reviews take place and daily records are kept. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 11 There was evidence of professional support being sought from outside agencies where appropriate, to include the speech and language therapy team, community psychiatric nurses, the continence advisor, opticians, chiropodist and residents’ doctors. Reference was made to minor skin abrasions for several residents and wound charts were in place to indicate the treatment being given and to monitor wound care progress. It was discussed that further advice is to be sought with one resident who was admitted with a heel pressure sore which does not appear to be responding well to treatment. Pressure relieving mattresses and cushions were in place where a need has been identified but a record of the equipment used was not always recorded. A few residents had been identified as nutritionally at risk and several required soft diets and assistance with their meals. Those at risk are weighed regularly to include one lady who is fed with a percutanoeus endoscopic gastrostomy tube (PEG). One had lost their dentures and arrangements were being made during the inspection for dental attention for this resident and others had been identified as having swallowing difficulties and were monitored closely at mealtimes. Procedures for the administration of medicines were checked and found to be satisfactory. The blister pack method of administration is used and the dispensing pharmacy carries out regular audits. Medication records were all checked and were well maintained. Photographs of each resident are kept in the medication record file. Medications are all stored correctly, dated on opening and a record of receipt and disposal is kept. The home has made arrangements to dispose of unwanted medication safely following advise from the pharmacy inspector from the CSCI. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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, 15 Residents experience a stimulating and varied life at the home with visitors encouraged. The home offers choice and variety of food, catering for special dietary needs but the menus are to be reviewed to ensure that the quality of food and meals planned maintain a good standard. EVIDENCE: The home provides opportunities for social activities and outings. Residents and one of the senior carers responsible for organising activities were spoken with during the inspection. The home actively fundraises with raffles and teas in order to have a number of trips out during the year. ‘Friends of Kingsley House’, in the main residents and their relatives, meet at least three-monthly to organise the events for the coming months. They are due to meet the week following the inspection. In recent months they have had a boat trip with the Willow Trust, have been to Horseworld and visited an organic sheep farm to help feed the lambs. Photographs of these events were on display in the dining room and several residents related how they had enjoyed these trips. Monthly communion is held at the home as well as a Songs of Praise held on special occasions, the next being harvest festival. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 13 Two gentlemen discussed the cricket which they enjoyed watching. The carer spoken with organises small group activities such as quizzes for those who enjoy such things but also ensures that she visits and chats to those who chose to remain in their rooms. A mobile cinema is also available and was amusingly mentioned in the homes’ newsletter. One lady visited had been given several recipe books to look for some ideas of what sort of meals she would like. Another had just received the talking book service and was getting used to this facility. The relatives spoken with were both satisfied with the care being given and the facilities provided. The kitchen was visited briefly during lunchtime preparation and the prepared food was viewed. Lunch was Spanish omelette on this occasion but was unusually combined with gravy. The manager confirmed that she is planning to review the menus shortly when they have successfully recruited further catering staff. Two alternatives to this lunch were seen: one being smoked fish and another being sausages. Menus were displayed in the kitchen with lists of individual preferences. The meal for the day was also displayed in the hallway. The cook confirmed that she also met special dietary needs for several diabetics at the moment and a number of meals are pureed for those with swallowing difficulties. Each food was seen as being pureed separately. Supplements are also provided where necessary. Those residents spoken with during lunch said that they had enjoyed their meal. Provisions were being made for one lady who had slept through her lunch to ensure that she was given a meal later. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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 & 18 Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: The manager reported that there had been no complaints received since the last inspection. The home has a complaints procedure in place, which is accessible to staff, residents and visitors. Each care file contains a form where any minor concerns raised by the residents are recorded and can be easily audited, and any action taken recorded. The home has a whistle blowing policy and policies and procedures related to Protection of Vulnerable Adults (POVA). All the policies and procedures are being reviewed at present. All new staff are instructed on this as part of the induction programme and it is also part of NVQ and adaptation training. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 A comfortable and safe standard of accommodation is provided for the residents. EVIDENCE: Although the home still employs a local maintenance man and local contractors for some emergency work, they now use a maintenance company who carried out an initial risk analysis and now work to a list of jobs compiled by the home, visiting the home once a fortnight. A tour of the premises was carried out with the manager and on the whole, the home appeared to be clean and well maintained. Since the last inspection all public areas and some rooms have been recarpeted, new ‘hospital type’ beds and some armchairs have been purchased and some areas have been redecorated. Redecoration generally occurs as rooms become vacant but in some cases residents are moved briefly while a room is painted. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 16 A few areas of wear and tear were noted such as ground floor room 6, which has already been scheduled for painting and it was reported that the hallway is also due for redecoration. Outside contractors also carry out all decorating work. New hoists have also been purchased and are just waiting for slings to be delivered. Two electrically controlled ‘profile’ beds were on loan from the local health authority. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 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 and one other qualified nurse were on-duty during the morning of inspection with seven care staff and one adaptation student. The manager was on-duty to 5 pm with a second qualified nurse on-duty from 2 pm to 8 pm with 4 care staff to 4 pm, 5 carers from 4 p to 8 pm, with an additional carer from 6 pm to 10 pm and two care staff and one qualified nurse during the night. Two care staff then started work at 7 am to increase the staffing to four care staff early morning. Through observations and speaking with residents it appeared that there were adequate staff on-duty to meet the current needs of the service users. The home has been assessed as suitable to train adaptation students linking with a university and are able to take 6 students in total. One has recently completed adaptation, another is moving to a hospital to complete the programme and there are several waiting to be allocated places. The university will be carrying out a third audit shortly. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 18 Two other overseas staff from Poland came initially into domestic positions until their language skills improved and are now engaged as carers and one is hoping to commence NVQ 2 shortly. The carer responsible for the activities organisation has recently completed NVQ 2 and reported that she is hoping to commence NVQ 3 shortly. Residents confirmed that they were very happy with the standards of care received from all the carers. Records of all newly appointed staff were checked during the inspection. All of these were from overseas and because some are adaptation students and others are recruited via an agency, none had complete staff records in place. One did have a POVA/CRB check prior to appointment but others had commenced prior to this check having been made. Several did not appear to have a fully completed application form and some had no application form at all; one had no medical details and one did not have written confirmation of physical and mental fitness. There were few records of interviews. The manager also reported that she was unaware that ancillary workers should have CRB checks. It is a requirement that a standard disclosure is obtained where there is regular contact but the job does not involve directly working with caring for or supervising vulnerable adults, for example domestic, catering or maintenance work. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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 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) 33 & 38 The home is managed efficiently but the systems for service user consultation need to be developed in order to ensure that their views are both sought and acted upon. The health, safety and welfare of service users and staff are promoted and protected through training and a regular programme of servicing and maintenance of equipment. EVIDENCE: The manager reported that satisfaction surveys had been sent out to each resident/their representative a year ago and to date only two had been returned. It was advised that this must be repeated and followed up to ensure that a quality assurance and monitoring system is put into place. Residents who are able and wish to, with/without their relatives may attend the three-monthly ‘Friends meetings’ which gives both the residents and their families the opportunities to put forward their views of voice any concerns. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 20 One relative produces an amusing newsletter of events at the home and this is sent to every family and was seen at inspection together with minutes of a ‘friends meeting’. Although the proprietor reportedly 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. Records of servicing and maintenance of equipment were seen to confirm that a safe environment is provided as far as is reasonably possible. Two residents are receiving continuous oxygen at present and one did not have a warning notice displayed and the other had an inadequate notice, which only stated ‘no smoking’. As part of the homes ‘ fire safety’ procedure, notices should be displayed anywhere oxygen is in use or stored to warn people especially the fire and rescue service of its presence. Records were also seen to confirm that staff have received moving and handling, fire and first aid training recently and the manager reported that several senior staff were responsible for weekly fire alarm and monthly emergency lighting tests. No one is currently completing random hot water temperature checks and keeping a record of these. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x x x x 2 Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 22 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 8 Regulation 17(1)(a) Requirement A record to be kept of the incidence of pressure sores and of the treatment provided to the service user. The registered person shall not 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. The Registered Provider must send to the Commission, a monthly report under the criteria of Regulation 26. Ensure that a quality assurance and monitoring programme is in place and maintained for reviewing at appropriate intervals and improving the quality of care provided at the home. The registered person shall ensure that unnecessary risk to the health and safety of service users are identified and so far as possible elimininated. Timescale for action 30/9/05 2. 29 19 30/9/05 3. 33 26 30/10/05 4. 33 24 28/2/06 5. 38 13(4) 30/10/05 Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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 38 Good Practice Recommendations Ensure the health and safety of staff and residents through:random checks of hot water temperatures and keeping records of same; display of notices warning where oxygen is in use/stored. Kingsley House Nursing Home D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 Page 24 Commission for Social Care Inspection 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 D51_D03_S16486_KingsleyHouse_V240644_300805_Stage4_U.doc Version 1.40 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. 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