Inspection on 12/03/08 for Kingsley Nursing and Residential Centre

This inspection was carried out on 12th March 2008.

CSCI found this care home to be providing an Good service.

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 Nursing and Residential... 04/04/07

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Kingsley Nursing and Residential Centre 36-40 Ripon Road Harrogate North Yorkshire HG1 2JJ Lead Inspector Anne Prankitt Key Unannounced Inspection 12th March 2008 09:30a 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 Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsley Nursing and Residential Centre Address 36-40 Ripon Road Harrogate North Yorkshire HG1 2JJ 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) 01423 560689 01423 521290 www.bupa.co.uk BUPA Care Homes (ANS) Ltd Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 years plus. Date of last inspection 4th April 2007 Brief Description of the Service: The home is owned by BUPA Care Homes. It is situated on a busy road within walking distance to the centre of Harrogate. There is a small garden area to the front of the building, and limited parking facilities to the rear. The accommodation is provided over three floors, which are accessed by passenger or stair lift. The home provides nursing care or personal care only for up to 43 people who are aged 60 or over. The manager confirmed on the day of the site visit that the current range of weekly fees was £373 - £550 excluding the free nursing care contribution where applicable. Additional charges are made for hairdressing, chiropody, papers/magazines, clothes labels, taxi fares (for planned hospital appointments or trips out) and toiletries. People who are considering living at the home are given a copy of the home’s brochure before they are admitted, so that they have information about what services the home provides. They are also given some financial information. Once admitted, people are given a copy of the service users’ guide. The inspection report is kept at the reception area, and the manager will give people a copy at their request. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Before the site visit, the manager returned a completed self assessment, called an ‘Annual Quality Assurance Assessment’. This gave information about Kingsley Nursing and Residential Centre. Surveys were sent to a selection of people who live at the home, their families, and some visiting professionals. A record has also been kept about what has been happening at the home since the last key inspection took place in April 2007. All of the information, including that which was gathered at the site visit, has been used as part of this key inspection. Five hours preparation took place before the visit, which lasted for approximately eight hours. The manager was available throughout the day, and feedback was provided to her and to the senior sister at the end. The site visit consisted of an inspection of the communal areas, and a sample of private bedrooms. Kitchen and laundry services were also looked at. A selection of documents were looked at, including a sample of care plans, health and safety records and staff records. The way that the manager collects information to check the quality of the home was also discussed. Some staff and people living at the home were spoken with, and observations were made to see how staff interacted with people. All of the information was used to get an impression about what it is like to live at Kingsley Nursing and Residential Centre. What the service does well: Staff always try to visit people before they are admitted to get first hand information about what their needs and wishes are. They write good care plans which are individual, and which look at people’s needs in a person centred way. Staff ask for advice from other professionals where they need help in making sure that they are giving people the right care, so that their health can be maintained or improved upon. A visiting professional commented ‘Since the new matron has started the organisation seems better.’ Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 6 People are offered choice in their daily lives, social activities are provided for people to join in with, and visitors are welcome at any time. This helps to make people’s lives more interesting, and to maintain important links outside the home. One person said ‘I’m up when I want and I go to bed when I want. I’m happy here. I’ve just got out of bed!’ (11.30am). The home is clean and kept maintained. This makes it a pleasant and safe environment for people to live in. People generally say that staff listen and act on what they say, and staff get regular training which helps them to give care in a safe way. People’s comments on the day included ‘We get more than we need’, ‘Well, this is a very good home. I’m quite happy’, I like it here – it’s one of the best hotels I’ve been in. Staff are nice and respectful. It’s fine really’. People’s views are taken note of both informally, and also officially, so that they can be looked at collectively to see where improvements need to be made in the home. This helps people to keep involved in the way that the home is run. The manager takes complaints seriously when they are brought to her attention. One person said ‘I refer my complaints to the manager who deals with them’. And staff know what to do if they think that people are not being properly treated. This helps to protect people from potential risk. What has improved since the last inspection? What they could do better: Thought could be given about how people could have the opportunity to see their contract. This would help them to understand who was paying for what element of their care. Improvements could be made to the way that medication is recorded, and how risks to people who want to self medicate are assessed. People’s views should not be overlooked where they are able to make their own decisions about their medication. These improvements will help to reduce the risk from avoidable errors and unnecessary confusion. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 7 People’s choice with regard to gender preference when receiving care could be reinforced with staff, so that people get their care in a way which causes them the least anxiety. To help people feel included and so that they have more control over their lives, staff could make sure that they do not stand over people when they are helping them with their meal. Staff could also make sure that they always ask before they use a communal space for general activities. And arrangements could be put into place so that people have access to their personal allowance at the weekend as well as during the week. To avoid the risk of people getting a meal which does not meet their dietary requirements, staff could make sure that the chef always gets information about people’s dietary and nutritional needs and risks as soon as they are admitted. Better evidence could be kept to show that that staff are not allowed to work alone at the home until all the necessary checks have been completed to confirm that they do not pose a risk to the people living there. And more robust arrangements could be in place so that staff always know whose help to call upon if an accident happens at the home which requires emergency first aid attention. To be satisfied that the premises remain fit for purpose, a check could be made to make sure that any requirements and recommendations made by the Environmental Health Officer at their last visit have not been overlooked, or the timescales exceeded. 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. The summary of this inspection report can be made available in other formats on request. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 8 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 Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 People who use the service experience good quality outcomes in this area. They can be confident that their needs will be assessed before they are admitted. But giving people the option of seeing their contractual arrangements would keep them more closely informed about their rights and obligations. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People are given a brochure to look at when they make an enquiry about the home. This gives them information about what the home provides. It also gives them advice about money matters. As part of people’s pre admission assessment, a senior staff member tries to meet people before they are admitted, so that they can talk to them about what care they need. They write down this information so that it can be shared with other staff. They also get information from other professionals who may have played a part in the person’s care. This could include information from the hospital, or from the care manager who supports them. This information Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 10 helps staff to make a better judgement about whether they will be able to meet this person’s needs before they are offered a place. One person spoken with said that before they were admitted, they were not in a position to visit the home personally. But they had appreciated meeting staff from the home. This, with the information that others had given them about the home, had given them enough information to decide that it would be suitable. In contrast, people who responded to their surveys did not think that they had been involved in their assessment before they had been admitted. One said that they were ‘just told’ that they were going to live there. Whilst the others said that their families had made the decision on their behalf. Neither had they seen their contract, which the manager said tends to go directly to the family member supporting the person concerned. She explained that she always offers people the opportunity to look round and spend time at the home before they have to make a decision about whether they want to live there, but that only one person has taken up this option in the last year. She is going to think about other ways in which she can offer people this service so that they are in a position to make more of an informed choice about their future home. She could also consider ways in which people could be given the option to see their contract, should they wish to do so. The home does not provide intermediate care. Therefore standard 6 is not applicable. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. Generally, people are cared for by staff who understand their overall needs and wishes. However, further improvements to the medication system would make sure that avoidable errors are kept to a minimum. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager and staff have worked hard since the last key inspection to improve people’s care plans. The new plans are more person centred and individual, because they look at all aspects of each person’s needs, whether they be social, psychological or health related. Not all staff have time to read the care plans in detail, but they all now receive an update about people’s needs before they start their shift. They said that this keeps them up to date about any changes that have been made to the way that individuals should get their care. The plans seen were reviewed regularly, sometimes with the person and their family where this was possible. The plans showed that staff assess risk to people. The manager gave an example whereby identified risk was discussed with the person concerned and a compromise sought so that the risk could be Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 12 minimised, whilst still considering their personal choice. This shows that people’s right to choose how they spend their lives, including the right to take reasonable risk, is being considered. However, another person needed a lot of care to keep certain risks to them to a minimum. Although assurance was given that this support had been provided, staff had not been keeping a regular record about how they were achieving this. Keeping a record helps others to understand what care has been given, when, and for what reason. This was put right straight away. The care plans explain what gender of staff people would prefer to get their care from. This information had not been put into practice for one person, who disliked being cared for by men. And a member of staff spoken with was not sure about any specific requests from people about gender preference. This needs to be reinforced with staff where special requests are made, so that they can meet people’s needs according to their wishes. Staff ask other professionals for advice when they need help to maintain people’s health and wellbeing. For instance, good links have been forged with the community matron, who provides relevant training for staff as well as professional support. This helps staff to keep up to date with current practice, and allows people to have continued contact with community professional support, to which they are entitled. Trained staff handle people’s medication on their behalf. The system is audited by the regional manager for the home on a regular basis, so that potential problems can be looked into quickly. There has been one medication error reported to the Commission for Social Care Inspection during the period since the last inspection. The manager had looked into how the error occurred, and has now made changes to the way that staff receive telephoned information. The system was generally well managed and maintained. Medication was stored safely, and at the correct temperatures. However, some matters, which needed to be improved upon, were discussed with the manager. Feedback has been provided that these have been or are being resolved: • • Some of the sheets used for recording medication were unclear. For instance, two hand written entries made by staff were confusing. This could lead to avoidable errors. The dispensing chemist had failed to remove from the sheet items which staff had told them were no longer required. So staff had to search for medication which was still relevant amongst sheets of unnecessary items. Although there have been no errors reported, these issues could increase the risk from them happening. This should be addressed with the pharmacist. Without talking to them, a visiting professional and a staff member had made a decision about how often an individual should receive their pain relieving medication. This person is capable of making decisions DS0000069199.V360800.R01.S.doc Version 5.2 Page 13 • Kingsley Nursing and Residential Centre • themselves, and lets staff know when they want their medication. This situation impacts upon the person’s right to remain involved in making decisions about how their health needs are managed. Staff were not sure which medications a recently admitted person managed themselves, and a risk assessment had not been completed to check whether the person was safe and happy to look after their medication. This could lead to confusion. At the site visit, people were spoken with in a respectful way, which helped to promote their dignity. People spoken with agreed that they like the staff who care for them. One person was pleased that staff knew what care they needed, and how they liked it to be provided. Their care plan identified that they had been involved in their review, which meant that they had been able to comment upon their care. This helps staff to get their care right. Five out of seven people who returned their survey said that they always get the care and support that they need, with six agreeing that staff always listen to and act upon what they say. Their comments on the day included ‘We get more than we need’, ‘Well, this is a very good home. I’m quite happy’, I like it here – it’s one of the best hotels I’ve been in. Staff are nice and respectful. It’s fine really’. A visiting professional commented ‘Since the new matron has started the organisation seems better.’ Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. The way that the home is run allows people to make choices in their daily lives, and to maintain important links with their families and friends. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home advertises a range of group activities. Those people who returned their surveys agreed that there were always or usually activities for them to join. One person particularly enjoyed the entertainers. Another said that they get a list of forthcoming events in advance. They appreciated this, because it allowed them to plan their time, and to choose what they wanted to attend. A new activities organiser, with previous experience, has just started to work at the home. The manager said that she has spent considerable time talking to people individually, and getting to know them. On the day of the site visit, an exercise game took place in a communal lounge. The people using the lounge could have been given more choice about whether they wanted to join in, or indeed whether they wanted the activity to take place in their lounge. However, they all appeared to enjoy the activity. Care staff have only limited time to spend socially with people. So it is important that the activities coordinator continues to provide individual activities for those people who are unable to join group activities. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 15 A representative of the Church of England visits monthly to carry out a communion service. The manager intends to make contact with other denominations, so that they can be called upon should people need them in the future to meet their spiritual needs. People can have their visitors whenever they please, and they can see them in the privacy of their own room, or in the communal areas if they would prefer. This helps people to maintain important links with family and friends. People are provided with choices in their daily lives. For instance, one person said ‘I’m up when I want and I go to bed when I want. I’m happy here. I’ve just got out of bed!’ (11.30am). Another person had just had their medication reviewed with the doctor, because the person wanted to change the times that they took their medication. The activities person asked people what they would like to do in the afternoon in her absence. Some chose to watch a film. One person said that they were going to sit and read the paper. A staff member delivered one person’s mail, who opened it in their own time. This attitude towards people helps to promote a feeling of control and belonging, and shows that staff are considering individual needs and wishes. People on the day said that they liked the meals at the home. Five out of seven people who returned their surveys said that they always or usually liked their meals, with two agreeing that this was sometimes the case. The dining tables were nicely set out, and people were given a choice to sit at the table, or to remain in their comfortable chair. Sometimes staff were observed standing over people whilst being helped with their meal. This could have made people feel rushed, and did not make the occasion feel very sociable. Also, plate guards used where people struggled to manoeuvre their utensils, were positioned wrongly. This increased the chance of people’s clothes becoming marked with food, which may cause them unnecessary embarrassment, and reduced their ability to remain independent. The manager was disappointed that this had happened, and has taken steps to make sure that this does not happen again. The chef explained that fresh vegetables are delivered to the home regularly. And fresh fruit was available in the communal areas for people to enjoy between meals. People can ask for snacks at any time, and they are offered a choice of menu at each meal time. The chef attends meetings held for people living at the home, and has asked them to tell him about some of their favourite recipes, which he would now like to incorporate into the regular menu. He has also followed the advice of the dietician where they have provided input for individuals, so that they get the proper diet to meet their nutritional needs. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 16 He explained that he visits people who are newly admitted to the home soon after arriving, when he finds out about their likes and dislikes. In one case, staff had not told him some important information about a person’s diet. This could have caused problems if the person had received a meal which, for health reasons, they should not have been given. The manager has addressed this shortfall with staff. Extra care must be taken to make sure that detailed information about individual dietary needs collected on admission is passed onto him. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. They can be confident that the manager will take seriously any complaint made to her, and will take appropriate action where necessary to put things right. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Five complaints have been made about the home since the last key inspection in April 2007. Four, regarding care practice, were referred to the local authority to be looked at under their safeguarding responsibilities. Meetings were held jointly with the local authority and the home, and with the Commission for Social Care Inspection where appropriate. These investigations have been completed, and the local authority is satisfied with the action taken by the home. The fifth complaint, received from a person living at the home, was dealt with professionally by the manager. Feedback was provided to the person concerned, who was satisfied with the action taken. This shows that the manager understands that all complaints should be treated seriously, and that failure to do so could impact on people’s daily lives. One person spoken with said that should they need to make a complaint, they would be happy to report it to a member of the senior staff. They were confident that they would receive feedback from staff about how their concern had been acted upon. However, one relative who returned their survey did not know how to complain. The second could not remember. But they agreed that the home usually responded appropriately when concerns had been raised. And one said ‘I refer my complaints to the manager who deals with them’. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 18 The manager did not know why people would not know how to complain. The procedure is displayed in the entrance of the home, and, following admission, people are given a copy of the service users’ guide, which also contains the complaints procedure. The manager has also reminded people about how to complain during meetings. As relatives generally deal with pre admission arrangements, it would be advisable for the service users’ guide, which contains the complaints procedure, to be given to people before admission, so that everyone has written information about how to complain from the offset. The staff at the home receive training in safeguarding people. They knew what action they should take should a person complain to them about their care. They also knew that they must pass on any information given to them where they were concerned that a person was not being treated properly. The company have provided them with a list of telephone numbers that they can call if they need to report any concerns. The manager too is clear about her responsibilities in reporting any matters which affect the vulnerability of people to the local authority for investigation. This will help to make sure that any concerns are investigated without delay, and will help to keep people protected. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. People live in a clean warm home which is kept maintained for their safety, and to which improvements are planned which will be to their benefit. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is situated on a main road on the outskirts of Harrogate town centre. There is a garden area to the front of the building, and a patio area to the side, where garden seating has been provided so that people can sit outside if they wish to. The premises were clean and fresh. People who returned their survey agreed that this was always or usually the case. The accommodation is provided on three floors. There are two sitting areas and two dining areas on the ground floor. There is also a small quiet sitting area on the second floor. Some of the corridors to the first floor are sloped, and do not give easy access for people in wheelchairs, or those with limited mobility. This could also cause problems for staff who need to move equipment Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 20 from one area to another. The company recognises that some parts of the environment are not ideal for the purpose of the home. They have plans in place to refurbish these areas, along with the redecoration of some individual bedrooms and communal areas. The refurbishment will be to the benefit of people who live there. There is a maintenance man employed who keeps in house maintenance up to date. He keeps a check on the safety systems relating to the premises. He checks the fire systems regularly, to make sure that they are in proper working order. This helps to keep the environment safe for people. The laundry is in the basement, so is separate from where food is prepared. The laundress was satisfied with the facilities provided, and said that staff make sure that she gets information when any infections in the home require extra vigilance on her part in order to reduce the risk from cross infection. Disposable bags are provided for the transportation of soiled linen, and protective clothing is provided so that infection control can be properly managed. This will help to keep people safe from unnecessary associated risk. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. Investment in training and supervision helps to make sure that people are cared for by well trained staff who know how to provide care in a safe and professional way. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager tries to maintain staffing levels at the home as set by the company. She occasionally uses agency staff, but only where necessary, because she prefers to use permanent staff who people living at the home know. This helps to provide better continuity of care. One relative thought that the service could improve if more staff were provided, and a person living at the home commented that the quality of care could differ depending on how many staff were available, and how well they knew the person’s needs. Though generally, people and staff thought that there were sufficient staff to meet needs, and to make sure that care was provided to meet personal choices. Six out of seven people who returned their survey said that staff were always available when they were needed. And it was recognised that more staff were being recruited in order to overcome perceived staff shortages. In support of this, the recent satisfaction survey completed on behalf of the company identified that 63 of people and their families thought that the number of staff available at the home was excellent or very good. This is better than last year when 40 felt that this was the case. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 22 As well as mandatory training, which all staff receive, they also get training from a variety of sources to help them in the work that they do, and to improve the service that they give to people. For instance the home works closely with the community matron, who provides in house training to staff based on the current needs of people who live there. This will help to make sure that the care people get is consistent, and meets with current best practice. Issues about privacy, dignity and respect are covered in ‘Personal Best’ training, which all staff complete. Staff are also encouraged to complete National Vocational Qualifications in care. A rolling programme is in place so that this can be achieved. This will help to give people assurance that they are looked after by a well qualified work force. The manager explained that she needed to update the training matrix to reflect the training that staff have received. She should make sure that this is updated so that she can see at a glance if and when training has fallen behind. However, staff were able to confirm where they were up to date with mandatory training, and, where gaps were evident, the manager confirmed that further training was planned. This will help to make sure that staff have the skills and knowledge to care for people in a safe way. The recruitment records showed that staff are not allowed to work at the home until the manager has received two satisfactory references and a ‘POVAFirst’ check. It was not possible to tell from the records the date at which the full Criminal Record Bureau (CRB) requested by the home had been returned. The manager intends to review this so that in future she had clear evidence. However, she is aware that only in extreme circumstances should staff be employed before the full CRB is returned. New staff receive a full induction and thereafter supervision. One person said that they had not had time to complete their induction properly. However, they said that they had not been asked to complete tasks they were unsure of. It is important that every staff member gets the appropriate support to complete their induction within a timely period so that they are fully conversant with the aims and objectives of the home, and the expectations of the company in providing good care for people. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience good quality outcomes in this area. People benefit from the input of an enthusiastic manager who listens to their views, and whose work to improve the home has been recognised. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager is a Registered Mental Nurse with management qualifications. She is currently studying towards her Registered Managers Award. She needs to apply to the Commission for Social Care Inspection, so that she can become the registered manager for the home. She has worked hard to engage with people, their relatives and staff over the last year. A staff member said she was ‘brilliant’, and commented upon the positive changes made to the home over the last eighteen months. Another said that she was ‘great’, and reported upon ‘changes for the better’ at the home. Another said that the company and the manager have made Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 24 improvements which mean that people living at the home now ‘come first’, and that the ‘care’ and the ‘food’ has improved. The manager has relocated her office so that she is more accessible to people. Those people spoken with knew her, and were confident that she would resolve any problems brought to her attention. She has told people about improvements she intends to make at the home, and has involved them in making decisions. For instance, she discussed the last inspection report with people and their families, and asked for suggestions towards the action plan for improvement. This helps to promote an open and trusting relationship. She has support from the regional manager who visits the home on a regular basis to check that it is running in line with BUPA policy and procedure, and in the best interests of the people who live there. The manager, or her heads of departments, complete regular audits of each of the service areas, to make sure that they continue to run as they should. This includes the catering, medication system, maintenance and care planning. As part of the quality assurance systems adopted by the company, important information is fed back to the company so they know where to focus their attention and resources in the future. She has introduced regular meetings, and has put aside protected time each week, so that people can meet with her, to discuss any concerns, and to tell her where they would like to see improvements made. One staff member said that the manager was ‘supportive’, and that she was ‘always talking to ‘residents’’. A visiting professional said ‘Since the new matron has started the organisation seems better.’ The company has recently asked people and their families their views about the home. The results have been published, and are available for everyone to see. They show a general improvement across the majority of areas in the home. In summary, 76 of those surveyed think that the home is now excellent or very good, which compares with 63 the previous year. This shows that more people are satisfied with what the home provides them. Some people are supported in managing their own financial affairs. Other people’s affairs are managed by their family. However, the home can keep people’s personal allowances on their behalf. A small float is kept at the home, and the remainder of their money is held in a collective bank account. The account accrues interest, which is shared out fairly to people depending upon how much they have saved. An overall balance is recorded weekly. People can have access to their money during the week, but not at the weekend. It would be of benefit to people if they could have access to money at any time. The manager intends to make enquiries to see whether this is possible. The manager has recognised that, as some staff have left, there may be occasional gaps in the provision of trained first aid cover, and is addressing this. In the interim, the manager must reinforce with staff who they must go to Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 25 in the case of an emergency, as some were not entirely clear. This will make sure that people get the right attention quickly. The maintenance man employed by the home makes sure that in house maintenance checks are kept up to date, and oversees the timetable for outside contractors, so making sure that servicing of maintenance equipment does not fall behind. This helps to keep people safe from unnecessary risk. The Environmental Health Officer has visited since the last key inspection. The maintenance man explained that two areas of paintwork in the kitchen stores and satellite kitchen, which needed attention, have not yet been addressed. He stated that that this work will be carried out during the refurbishment of the home. As the visit took place some time ago, the manager should check that the timescales given by the Environmental Health Officer have not been exceeded, and that any required maintenance has not been overlooked. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 26 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Timescale for action 12/03/08 2 OP15 16 3 OP29 19 Schedule 2 To reduce the risk from error and confusion: • Hand written entries made by staff on medication records must be written clearly and correctly. • A risk assessment must always be completed for people who choose to self medicate to check that they are safe and confident to do so, and the person’s records must clearly identify which medication is self managed by the person concerned. Care must be taken to make 12/03/08 sure that important information about people’s diet is passed onto the chef, so that their nutritional needs are met, and any risks associated with their diet understood. For all future recruitment, clear 12/03/08 information must be kept to evidence that staff at the home have been deployed only after all the necessary checks have been completed to confirm that they do not pose a risk to the people DS0000069199.V360800.R01.S.doc Version 5.2 Kingsley Nursing and Residential Centre Page 28 4 OP38 13 living there. Arrangements must be in place 12/03/08 so that at all times staff are clear who they must go to when first aid cover is needed, so that the right action is taken by the appropriately qualified person in the event of an emergency. Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 29 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 Refer to Standard OP2 OP9 Good Practice Recommendations People should be given the option of seeing their contractual arrangements. This would keep them more closely informed about their rights and obligations. The opportunity for people who have capacity to make decisions about their medication, and when they want it, should not be overlooked when changes are made to the way their medication is prescribed. People’s choice with regard to gender preference when receiving care should be reinforced with staff, so that people get their care in a way which causes them the least anxiety. To afford people maximum control in their home, they should always be consulted to check that it is acceptable for their communal space to be used for group activities. To make the occasion more social, staff should not stand over people when assisting them with their meal. New staff members should always get the appropriate support and direction to complete their induction within a timely period, so that they are fully conversant with the aims and objectives of the home, and the expectations of the company in providing good care for people. To give people more choice and control, they should be able to access to their personal allowance at weekends as well as during the week. To ensure that the premises are being kept fit for purpose, a check should be made to make sure that that the timescales given by the Environmental Officer in their most recent report have not been exceeded, and that any required maintenance has not been overlooked. 3 OP10 4 5 6 OP14 OP15 OP30 7 8 OP35 OP38 Kingsley Nursing and Residential Centre DS0000069199.V360800.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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