Inspection on 04/04/07 for Kingsley Nursing and Residential Centre

This inspection was carried out on 4th April 2007.

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 Nursing and Residential... 12/03/08

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Hawkhills

Larchfield Manor

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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 4th April 2007 09:30 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.V335017.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.V335017.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 ANS Homes Limited 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.V335017.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 years plus. Date of last inspection Brief Description of the Service: The home is owned by BUPA Care Homes. Due to a technical change in company arrangements, the service is classed as a ‘new registration’, following a completed application made to the Commission for Social Care Inspection. However, it is an existing service, and this arrangement has made no detrimental changes to the way that the home is run. The home 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. There has been a new manager appointed at the home, who had been in post for approximately four weeks when the site visit took place. 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 £400 - £784. Additional charges are made for hairdressing, chiropody, papers/magazines, taxi fares (when the hospital ambulance is not available) and toiletries. Prospective service users are given a copy of the home’s brochure and service users’ guide before they are admitted, so that they have information about what it provides. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the newly appointed manager sent a completed questionnaire to the Commission for Social Care Inspection. It provided information about the home, including who lives and works there. The inspector has also kept a record about what has been happening at the home since the last inspection. So that their views could be sought, surveys were sent to each of the residents and their relatives. They were also sent to some health professionals and care managers. Ten residents, fifteen relatives, five health professionals and two care managers returned their surveys. Five hours of planning took place before the site visit. The site visit lasted for eight hours. Time was spent talking with residents, staff and the newly appointed manager of the home. Time was also spent watching the general activity in the home. Some records were looked at, including a sample of care plans, health and safety records, staff files and the records of complaints. All of the information was used as part of this key inspection. The manager was available throughout, and feedback was provided to her at the end of the site visit. What the service does well: Residents benefit from a clean, homely environment. People have a proper assessment before they are admitted to the home. This checks that the home will be able to meet their needs. Staff provide residents with care in a dignified way. They acknowledge the individual choices of residents. Residents are able to maintain important links with their families and friends, who are welcome at the home at any time. The newly appointed manager takes complaints seriously. She and her staff would report any concerns to the proper people for investigation if they were concerned that a resident was at risk from abuse. The range of training provided to staff helps make sure that care is provided in a safe and proper way. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 6 The new manager is enthusiastic, and wants to consider the views of the residents, staff and relatives when looking at making improvements in the way that the home is run. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 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 Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. Prospective service users are assessed before they are admitted, to make sure that the home will be able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the records seen, it was evident that the manager, or another appropriate staff member, carries out a pre admission assessment visit before prospective service users are admitted to the home. This helps to check that the home is able to provide the care that is needed. Although the reason for admission may be understood by staff, they need to make sure that this is always recorded. Whilst it is sometimes family members who visit the home on their behalf, the manager explained that service users are also encouraged to visit before they make a decision about whether the home is suitable for them. One service user who had recently moved in said: ‘I could have looked round, but I decided not to. My daughter got a brochure for me and looked round instead’. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 9 The majority of service users who returned their survey were happy that they had received enough information about the home before they moved in. The manager confirmed that the home does not provide intermediate care. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. Service users receive care from staff who understand their needs. Further improvement to the care plans and the medication audit would make sure that important issues are not overlooked. This judgement has been made using available evidence including a visit to this service. EVIDENCE: New care plan documentation has been introduced. It requires staff to complete a reassessment following admission, and then on a regular basis, so that any additional needs or risks identified following the preadmission assessment can be added to the care plan. This helps to make sure that staff know what care each service user needs. Although staff have been subject to mandatory training before being allowed to complete the new care plan documentation, it appears that not all staff were following the clear guidance set out by BUPA. In some cases monthly reviews had fallen behind, risk assessments omitted, and information, including life histories and end of life arrangements had not been completed. The responsible individual is aware that further training is needed, and a meeting has already been planned so that this can be provided. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 11 For instance, a completed nutritional risk assessment was seen within only one file. The care plan of one service user who was prone to pressure sores, and where the nutritional assessment should have been completed, contained no such information. In another case, the daily notes were being used to record events relating to the referral of a service user for whom advice had been requested from outside health professionals. The fact that the information had not been recorded in the proper place may have contributed to the fact that the final referral had not been made by staff. This meant that access to the relevant service had been delayed for the service user. The manager agreed that this care plan would be reviewed straight away, and the referral made. The review must include current areas of risk which may affect the service user’s well being. Despite these shortfalls, staff have provided some good information on which to build upon, which includes information about how to meet the needs of service users who suffer from dementia, or who have limited communication. With further development, the plans will give a good overview of the needs and associated risks of service users. The manager is keen to provide staff with support so that this can be achieved. It appears that care staff who begin their shift at 2pm do not always receive a report from the morning shift. This was the case on the day of the site visit, although the staff member had been given information about a new admission due to arrive at the home. Two relatives commented separately: ‘Daily staff do not pass on proper information to changing shifts’, ‘I would like to be informed when they call the doctor for my relative’. All staff need to have an update before they start their shift to make sure that they are giving service users the correct care. Following a recent investigation at the home, staff communication is an area which the responsible individual wants to see improvement in, and which she is monitoring. Of the five health professionals who responded to their survey, four provided a positive response. One stated that the home works very well with them, and asks for appropriate advice whenever needed. Another stated ‘Some nurses very caring and good support’. Concerns regarding the possible overuse of health services and communication problems detailed within one reply were passed anonymously onto the manager. Service users spoken to on the day were very positive about the care that they receive, which they thought was provided with dignity and respect. Their comments included ‘All the staff are very nice’, ‘The staff are marvellous – very kind’, ‘I can’t fault this place at all’, ‘I couldn’t wish for any more’, ‘My needs are met’. Responses from surveys were mainly positive. A service user who was unhappy that they had been made to wait for assistance until after a staff member had taken their break had made a formal complaint direct to the manager. The manager had taken action by referring Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 12 the staff member for ‘Customer Care’ training, as she agreed that the response had been unacceptable. A number of relatives reported a slow improvement in the home, and the majority praised the care that their family receive. ‘I know the standard of care is first class’, ‘I had concerns but feel the situation is improving’, ‘Friendly staff look after mum well’, ‘The care in the Kingsley has improved in the last few months.’ There is a trolley available at each side of the home, so that service users’ medication is kept secure. Medication kept on behalf of service users is signed into the building upon receipt, and a list of medication disposed of is also kept. Medication administration records are kept, which were mainly up to date, and controlled medication was appropriately stored. Approval is sought from the General Practitioner whenever a service user wishes to self medicate. They are provided with a lockable drawer for safe storage. A staff member advised that the risk assessment is then reviewed regularly with the care plan to make sure that the arrangement is still safe for the service user. One controlled medication with a limited shelf life had passed it’s expiry date based on the date that it was dispensed, and no record had been made of when it had been opened. The staff member was asked to remove it from stock for disposal. Staff do not currently sign when ‘when required’ (prn) medications are not given. This could lead to avoidable errors. Advice was provided to staff about ways to improve upon the recording. It was agreed that one service user who has refused one of their prescribed medications for at least three weeks, needed to be referred to the GP for review. The manager agreed that this would be done. Staff have made the system more flexible for service users, so that they are not woken early as part of the routine to be given their morning medication, unless this is their wish. This is good practice. There has been one medication error reported by the home to the Commission for Social Care Inspection (CSCI) since the home re-registered, following which a complaint was made to the CSCI by the family of the service user concerned. The complainant was also concerned about the reliability of the equipment used to take blood readings. The matter was referred to the responsible individual for BUPA who carried out a full investigation into the matter, which has now been concluded. The company fed the outcome back to the complainant and the CSCI. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is good. The social and spiritual needs of service users are considered, and they are able to maintain important links with friends and family. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities co-ordinator has been recruited to work at the home. They have undertaken a range of training, which helps them to provide meaningful activities for service users. The programme advertised includes protected time, which is spent with service users in their own rooms. For instance, one service user who remains in bed enjoys classical music, and one to one time when extracts from the daily paper are read to them. This is good practice. There are a number of group activities involving board games, to which those with hearing impairment can join. There is also a shop from which service users can buy small items such as sweets and toiletries. A newsletter has also been circulated to service users and relatives. The activities organiser intends to produce these on a regular basis. The manager said that she would also use this to provide information about any relevant Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 14 plans that have been made for the home. This will help to keep service users and relatives informed. Regular visits from the local Church of England and Roman Catholic denominations have been organised, to include communion for those service users who would wish to join in. Communion is also held. There are currently no service users accommodated with diverse spiritual needs. Service users’ comments included: ‘There is always something going on’, ‘I go to things when I feel like it’, ‘I would like more opportunity to go outside even if just to sit in the garden’. Relatives commented: ‘The introduction of some entertainers and stimulation for the residents has made a notable change for the better’, ‘Since the introduction of the activities programme there seems to be so much more laid on for residents’. ‘Keep up the good work on the social side!’. The activities programme is flexible to meet the wishes of the service users, who took advantage of the warm weather on the morning of the site visit when they sat outside at their request. Planned activities took place in the afternoon instead. Service users were happy that their family and friends could come and go as they pleased, and that they were able to maintain important contacts in the community. For instance, one service user had arranged to have lunch in Harrogate the previous day with their friend. Another said: ‘I can have my visitors whenever’. Private bedrooms contained personal belongings. Service users’ clothing appeared well laundered and pressed. Those asked were happy with the laundry service. One complaint made about some clothing and personal items which had gone missing, had been recorded by the manager. She was in the process of negotiating reimbursement after acknowledging the shortfall in the service provided to the service user concerned. The routine for service users has become more flexible. Their choice with regard to rising and retiring times is considered, decisions about where they would like to spend their day are listened to, and the medication routine has become less institutionalised. One service user commented: ‘I spend my day as I please. The girls (care staff) help me when I ask them.’ The communal areas have been reorganised so that additional dining space has been made available, so that the mealtime becomes more of a social event. Service users were helped with their meal in a dignified way when this was needed. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 15 There are menus available around the dining areas to remind service users of the choice that is available at each mealtime. The manager is planning on having these redesigned so that they are more easily readable for those who are sight impaired. Comments about the meals were very positive on the day of the site visit, and service users appeared to enjoy the mealtime. Their dining tables were beautifully set out. All spoken with were happy with the food on offer. The majority of service users who returned their survey either always or usually enjoyed their meals. Their comments on the day included: ‘The trouble is, I like the food too much!’, ‘The food is lovely’, ‘The food is good – can’t fault it – the meat is tender’. Isolated comments made within surveys about the quality and serving temperature of food were passed on anonymously to the manager for consideration when she carries out the monthly quality audit. The manager has also dealt with one formal complaint from a service user who chooses to eat in their room. Because all courses were delivered at once, the meal was cold. To resolve this problem, food is now delivered a course at a time. The chef explained that staff provide them within sufficient information so that they are able to provide service users with the correct diet. They said that fresh meat is delivered to the home from a local supplier three times each week, and a fresh vegetable is served every day. Drinks and snacks are available to service uses over a twenty four hour period. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. Complaints brought to the attention of the management are dealt with, but delays in reporting complaints to the manager could result in service users’ confidence in the complaints procedure being damaged. But service users are protected by staff who will make sure that matters which involve abuse are reported to the appropriate person. This judgement has been made using available evidence including a visit to this service. EVIDENCE: BUPA Care Homes have a clear complaints procedure, which is included within the service users’ guide. There has been one complaint made direct to the Commission for Social Care Inspection during the period since the home was re-registered. This was referred to the home for investigation. The home has kept the Commission informed about the action that they have taken, and about the contact that has been made with the complainant. The complaint is referred to within outcome area ‘Health and Social Care’. Two complaints have been made directly to the home. One was made by a relative, and one by a service user. There was a record kept of the action taken by the manager following the complaint, and of the outcome of the investigation. These are referred to further within outcome areas ‘Health and Personal Care’ and ‘Daily Life and Social Activities’. One complaint made the previous day to a member of staff by a service user had not been passed onto the manager for attention, nor had it been recorded. The staff member was Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 17 advised to report the concerns to the manager for action. The manager now intends to look into the dissatisfaction raised by the service user. There have been seven compliments recorded which have been made by relatives direct to the home, and which praise the service given by staff. All service users spoken with or surveyed knew how to make a complaint. All but one relative knew how to complain direct to the home. However, comments from relatives included: ‘Not always easy to find relevant members of staff if there is an immediate issue to discuss’, ‘Not sure how to complain since the (previous) manager left. But would write to BUPA direct’. ‘They didn’t respond promptly to a complaint in the past, but feel that they would now’. The manager has already recognised that, due to the location of her office, she is not immediately visible to service users and visitors. Representatives of BUPA Care Homes have plans to make sure that she can be more centrally located. All staff have recently had updated training in abuse awareness. They have instructions to follow which explain the action they must take taken if abuse is ever suspected. Those spoken with knew the importance of passing on their concerns. They also knew that, in order to protect all service users in the home, they were unable to keep secrets where abuse was alleged or suspected. This helps to protect service users from potential risk. The responsible individual makes sure that all safeguarding adult issues are referred to the local authority for consideration of investigation, and the newly appointed manager was fully aware of the local authority’s role as lead investigator. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 18 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. Quality in this outcome area is good. Service users live in a clean and pleasant environment which is kept maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was spotlessly clean and tidy at this site visit. There are two maintenance men who provide a regular service to this, and a further two homes in Harrogate, which are also owned by BUPA Care Homes. This includes the regular checking of the fire systems and equipment such as bed rails. They make sure that in house maintenance and services provided by external contractors are kept up to date. The service is provided on three floors. Corridors are quite narrow and in some places quite steeply ramped. This could potentially cause problems for people who may be wheelchair dependent, and should be considered during the pre admission assessment of service users. However, there were no concerns raised at this site visit, or within any of the surveys returned. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 19 The layout also provides challenges for staff, who are required to manoeuvre hoisting equipment around the home. However, an audit is to be undertaken by a hoisting company, so that equipment can be provided, if required, which will be easily manoeuvrable around the corridors and between floors. Service users said that they were pleased with the recent changes that have been made to the layout of furniture in communal areas. This means that, in the conservatory area, they are now able to look out of the window at the garden and passing traffic. They said that they enjoy this. These changes have resulted in the loss of a ‘quiet room’ in one area of the home. Comment was made that it is difficult to find a quiet area for visiting, away from the television. The manager was aware that this could be an issue. She intends to discuss the matter with the service users, to see what, if any further changes, they would like to have made. This is good practice, as it includes service users in the running of the home. As part of future plans, the garden will be provided with a sensory area, so that it is more attractive for service users, and the rolling programme of refurbishment includes the redecoration of bedrooms as and when required. The laundry is situated in the basement area. There is a staff member allocated to laundry duties each day, so that care staff can concentrate on providing care. The washing machines are fitted with sluicing devices, and soiled linen is delivered in separate ‘bio bags’ so that staff working in the laundry do not have to come into contact with the soiled linen. There is also a supply of disposable gloves and aprons available. This helps to reduce the risk from cross infection. Staff undertake training in infection control. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is good. Staff are provided with training and supervision to help them provide good care in a safe way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were thirty two service users accommodated at the home, out of a possible total of forty three. Care staff numbers had been reduced accordingly. Staff said that seven care staff were provided each morning, and six each evening. Some commented that sometimes these numbers were reduced further when sickness occurred. Although those service users spoken with thought that their needs were being met, these staff thought that it was a struggle for them to achieve this when the numbers were not maintained. Comments on the day of the site visit from service users included: ‘There are enough staff’, ‘I am sure there are enough staff. I ring my bell and they come’. Relatives comments were less positive, and included: ‘The care can vary from day to day depending who is on duty’, ‘Maybe they need more staff – sometimes like the Marie Celeste’, ‘The phased takeover by BUPA has obviously had some effect on the staff and the functional running of the home’, ‘There are never enough staff. It’s either too many or nobody about.’ ‘It’s like the Marie Celeste sometimes so if someone needs the toilet then they usually have to wait.’ Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 21 The manager has already identified that this is an area which she needs to look at more closely. She intends to carry out a survey to capture the views of service users and staff, so she is able to identify whether there are ways in which staff could be better deployed. However, she has given assurance that the staffing levels will be restored once the occupancy increases. There has been one staff member recruited since the home was re-registered. The manager had carried out a thorough recruitment process. This helps protect service users from unnecessary risk from unsuitable workers. The manager confirmed that the staff member was now undertaking a period of induction prior to being deployed at the home. There is a rolling programme in place for NVQ training in care, with staff currently working towards the award. There are also additional training opportunities for staff. Some have completed training in dementia awareness. The manager is a Registered Mental Nurse. To help staff have a better understanding about the needs of people with dementia, she intends to use her knowledge to provide additional training to them. On the day of the site visit, she was providing one to one training for one member of staff who she identified would benefit from this. This is good practice. Qualified nurses are provided with training opportunities to update their professional knowledge and skills, and the manager is currently planning to introduce clinical supervision. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is good. The home is run by a manager who is keen to make further improvements to the quality of the home, by listening to service users, their relatives and staff, and considering their views. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for four weeks. She explained that a manager from another home owned by BUPA Care Homes has provided her with good mentorship during her induction period. The responsible individual has also provided her with weekly support, which she has appreciated. She has a positive and enthusiastic attitude towards her work, and it was clear that she has already made herself known to service users. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 23 She is a Registered Mental Nurse, with considerable experience in the care of older people, having worked previously in a management position. She also has a management qualification. She is also a qualified speech and language therapist. She is in the process of applying to become registered with the Commission for Social Care Inspection. She is looking at what further management qualifications she will need to take as part of her role. Service users and staff spoke very positively about her input. Staff were particularly impressed that she will involve herself in every day nursing practice. Their comments included ‘With input from the previous acting manager and also the new manager there have been changes for the better’. ‘The manager is trying her best. She is sorting out things that haven’t been done but is still dealing with service users’ needs’. She has already held a residents and relatives’ meeting, and intends to hold a further meeting in the near future. She explained that relatives were keen to raise concerns that they had with her, so she has decided to set up a weekly ‘surgery’ when they are able to meet her without appointment. This will commence in the near future. She stressed however, that she operates an open door policy at all times. BUPA Care Homes carry out annual surveys of service users, relatives, and professionals who have an interest in the home. The results are collated and an action plan produced. The manager is currently working on the action to be taken from the most recent survey. As well as the formal annual survey, the manager is keen to seek the views of residents on a regular basis with regards to the running of the home. The company is also looking at plans so that the manager’s office can be relocated to a more central point, so that she is more readily accessible. Personal monies are held securely for a number of service users. A small float is kept at the home, and the remainder of monies is held in a collective bank account. The account does not accrue any interest. An overall balance is recorded weekly. Service users can have access to their monies upon request, and receipts are kept when transactions are made on their behalf. Service users who wish to handle their own affairs would be supported in doing so, and individual lockable facilities are available where they may keep their valuables. The home is kept maintained. Action has been taken to address those issues which needed urgent attention from the most recent fixed wiring certificate and full fire inspection. Work has also been completed to meet shortfalls identified in the recent gas landlord’s report. Further work will be carried out as deemed necessary following an additional inspection report. Regular fire safety checks are undertaken, and records kept. This helps to protect service users from unnecessary risk. Staff undertake a range of statutory training to help them provide care in a safe way. On the day of the site visit the manager was providing two training Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 24 sessions for all staff in health and safety. Fire training update was planned for the following week for all staff. The manager needs to expedite her plans to source training for staff in first aid, so that she can make sure that there is a qualified first aider available on each shift. The kitchen keeps good records, and food appeared to be stored appropriately within the fridges and freezers. Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 25 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 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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 The registered person must make sure that review of the care plans is carried out, giving priority to those where information about risk assessments and social needs has not been completed. Staff must make sure that referral to the appropriate health professional is made for the service user discussed so that their current health needs can be reviewed. The audit of the medication system must include close attention to the date at which medication expires. Staff must make sure that they record and pass on complaints to the appropriate person without delay, so that they can be investigated promptly. Training must be organised so that there is at least one first aid trained person in the home at all times to make sure that service users receive appropriate treatment in an accident. Timescale for action 31/05/07 2 OP8 13 04/04/07 3 OP9 13 04/04/07 4 OP16 22 04/04/07 5 OP38 13 31/05/07 Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 27 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 OP7 OP8 Good Practice Recommendations All care staff should receive a proper report before each shift so that they are made aware of any changes to service users’ care needs, and how they are to be catered for. Where service users are able to tell staff when they need their ‘when required’ (prn) medication, this should be recorded in the care plan. The medication records should then be signed when the medication is actually administered. Where the service user is not able to decide, and staff are making a decision on their behalf about whether or not they need their medication, then the home should record on each occasion why the medication has, or has not, been administered. It is recommended that the manager pursue her plan to carry out a survey to check that staff are being appropriately deployed. 2 OP9 3 OP27 Kingsley Nursing and Residential Centre DS0000069199.V335017.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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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