Inspection on 14/10/08 for Kingsley Nursing Home

This inspection was carried out on 14th October 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 Home 30/10/07

Kingsley Nursing Home 03/10/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingsley Nursing Home 18 - 20 Kingsley Road Northampton Northants NN2 7BL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home Name of care home: Address: Kingsley Nursing Home 18 - 20 Kingsley Road Northampton Northants NN2 7BL 01604712411 01604711199 Carehome32@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Alison Moore Type of registration: Number of places registered: Hollyberry Care Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Hollyberry Care Limited is registered to provide personal care at Kingsley Road Nursing Home for both male and female service users who fall within the following categories :Dementia - over 65 years of age DE(E) 25 Physical Disability - over 65 years of age PD(E) 25 Old age not falling into any other category (OP) 25 Kingsley Road Nursing Home is registered to accommodate a maximum of 25 service users To admit into Kingsley Road Nuring Home the person named in variation number V38033 who falls within category MD Date of last inspection Brief description of the care home Kingsley Nursing Home is a private nursing home and is registered to accommodate up to 25 older people, and can provide care for people living with dementia-related Care Homes for Older People Page 4 of 39 0 0 0 Over 65 25 25 25 Brief description of the care home conditions, and people with a physical disability. Kingsley Nursing Home is a large Victorian house situated in central Northampton opposite the racecourse, local shopping and leisure amenities are close by and the home has good access to local transport facilities. There are a number of single bedrooms, with and without ensuite facilities and four shared bedrooms. On the ground floor there is two lounges and one dining room. A central lift provides access to the first floor, and ramps and grab rails are fitted internally and externally around the property to assist people with limited physical mobility. To the rear of the property there is a pleasant garden and a private parking area. The fees range from £449.00 to £566.00 per week. This information was provided by the Registered Manager during the site visit. People are responsible for all other personal expenditure such as personal toiletries, hairdresser and chiropodist. The homes statement of purpose and service user guide are made available to prospective residents and their representatives, these documents set out the aims and objectives of the home and provides clear information on the range of services available within the home. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We as it appears throughout this Inspection Report refers to The Commission for Social Care Inspection. This key inspection consisted of preparation by reviewing the last inspection report dated 30th October 2007. We looked at the information we had about the management of Kingsley Nursing Home, having recently had a registered manager and any information that affects the wellbeing of the people living at the home. The registered manager sent us the completed annual quality assurance assessment document that Care Homes for Older People Page 6 of 39 reflects their assessment of the standards in the home. We sent out twenty-two surveys to people living at Kingsley Nursing Home, of which eleven were returned, completed with the assistance of relatives in some instances. All the responses we received and the comments indicated people and their relatives were involved in choosing Kingsley Nursing Home, were happy with the level of nursing care received and the home environment. We sent out twenty staff surveys of which ten were returned. The responses and comments received indicated that staff were recruited, trained and supported by good systems and management to care for the people living at Kingsley Nursing Home. The comments received have been included throughout the relevant sections in this inspection report. We visited Kingsley Nursing Home on 14th October 2008 starting at 09:30hrs and finishing at 16:45hrs. The registered manager assisted us during the site visit of the service. The main method of inspection we used was case tracking. This means looking at the range of nursing care people received that ensures their needs are met whilst their independence, rights and choices are promoted. This was done by selection four people who have different care and nursing needs and include a new person that moved to the home recently. We spoke with a number of people that were able to talk to us, visitors and a visiting physiotherapist. We read the care files containing information about peoples care and nursing needs and preference of lifestyle. We spoke with the staff on duty: registered trained nurse and nursing care assistants and read their recruitment and training files. We made observations of people, how they were treated and saw the interaction by staff with the people they cared for. We looked at the living accommodation from the communal areas, bathrooms and individual bedrooms. We read the information people received about Kingsley Nursing Home, policies and procedures and specific records that demonstrated the day-to-day management of the home. The Commission for Social Care Inspection has a focus on Equality and Diversity, which are reflected throughout the main body of this inspection report. What the care home does well: Kingsley Nursing Home is a well established care home with nursing set on a busy main road in Northampton, opposite a large park. The registered manager is also a registered general nurse, is committed to providing good nursing care and comfortable living environment for people. People and in some instances their family are involved in choosing Kingsley Nursing Home from the initial visit, assessment and admission process to ensure the nursing needs are met in a manner that suits people. People are involved in review meetings of their nursing care plan, and encouraged to raise issues or express concerns. We observed people living at the home and their relatives were treated with respect and dignity, showed sensitivity and compassion when offering assistance. Visitors are welcome at all times and made to feel they are visiting people in their own home. The family of people living at the home are encouraged to participate and support the social events to create a family atmosphere. People are encouraged to join in activities held at the home, from exercise with the physiotherapist, beauty and nail painting to planned social events such as the Halloween Party. People have a good choice of meals, prepared to suit special dietary needs. Staff were seen assisting people with their meals in a sensitive manner that promoted their dignity. There is a stable staff team, recruited and trained to competently meet the nursing care needs of the people living at the home. Staffing levels are sufficient to meet the needs of people, having a trained nurse on duty at all times. People spoke highly about the staff that support them. Staff demonstrated a good awareness of peoples needs and ways to respond that does not agitate or upset people. Staff receive regular supervision to help identify training needs and developments and attend regular staff meetings to keep up to date with new information and practice. Staff training is promoted through continuous development and trained nurses ensure they maintain their skills and registration with the National Midwifery Council. People and their visiting relatives felt confident to complain. People were confident to raise matters immediately with the staff or the registered manager. Kingsley Nursing Home is a comfortable and homely environment for people to live. There are a number of small lounges and dining room that encourages people to choose where they wish to spend the day. A number of people remain in bed, receiving a greater level of nursing care and are seen by staff and nurses frequently to ensure they are comfortable, follow measures to promote wellbeing, provide regular contact, drinks and food. There are specialist equipment in place such as hoist, pressure mattresses and special beds to meet peoples nursing needs. The bedrooms are individual, spacious and personalised with personal ornaments, pictures and photographs. The records relating to the people living at the home, the staff and the day-to-day Care Homes for Older People Page 8 of 39 management are kept in good order, secure and in line with data protection. Staff demonstrated responsibility in relation to confidentiality. Staff were confident to recognise the needs of people and ensured their care practices, protected people from harm and abuse. The comments we received from people living at the home, visiting relatives, staff and comments made in the surveys included: My sister-in-law and I came to have a look around and at the time they had a vacancy. The care delivered, the kindness of the nurses has been second to none. Its very much as we expected Always friendly and helpful however busy they might be The staff usually organise the activities and the residents seem to enjoy them We have very good working relationship with our GP, MDT,e experts in different fields. I feel that I can access any specialist knowledge I may need i.e. tissue viability nurse. We also have regular contact with the local churches The staff are dedicated to their tasks The home and the surrounding garden are clean and pleasant I am comfortable, secure and safe in my home I am very happy with the home, they are always helpful Good food, good care and good staff What has improved since the last inspection? Kingsley Nursing Home now has a registered manager, who is a registered general nurse. The registered manager successfully completed the registration process with the Commission for Social Care Inspection and deemed to be a fit person to manage Kingsley Nursing Home. The registered manager is working towards a level 5 coaching and mentoring certificate from the Institute of Leadership and Management. A new nursing care assistant has been recruited to ensure the staffing levels and skills meet the needs of the people living at the home. The home has introduced a key working system whereby, staff are responsible for tidiness of personal belongings and liaising with relatives, for the purchase of toiletries. People are offered a range of social activities and informed through residents meetings and the homes newsletters. The registered manager has made inquired about palliative care and development information folders to ensure staff are kept up to date with developments and practice. The registered manager and deputy registered nurse completed an activities course to look at promoting a range of activities to suit people needs and interests. The trained nurses are trained in venepuncture, which means trained to take blood samples. Care Homes for Older People Page 9 of 39 The information about Kingsley Nursing Home has been updated to reflect the appointment of the registered manager. The complaints procedure has been updated and is now available in large print. The home environment is continuously upgraded, decorated and improved depending on the needs. People now have individual fire evacuation plans following the recommendation made by the Fire Service. Alco-gels are placed in the hallway and visitors are encouraged to use on entering and leaving the premises to promote peoples, health and safety. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good information about the home, encouraged to visit and are involved in the assessment process that ensures their care and nursing needs are met. Evidence: We read Kinsgley Nursing Homes statement of purpose and the mission statement, which tells people about the facilities, the type of service people can received, the skills, the nursing qualifications of the staff and the management. The information is well presented and easy to read. It details the assessment process to receive nursing care and the key policies and procedures such as the complaints procedures. The information we received from the registered manager before the site visit stated all prospective residents are encouraged to visit and have a months trail visit. The surveys responses we received from the people living at Kingsley Nursing Home confirmed they had received enough information about the home before moving in and received a contract detailing the terms and conditions of stay. Therefore, the Care Homes for Older People Page 12 of 39 Evidence: information we received supported our findings during the site visit. We case tracked four people, all having a range of care and nursing needs including a person that had moved to the more recently. We spoke with the newest person that had moved to Kingsley Nursing Home and their visiting relative. The relative told us they visited several times, having the opportunity to see the home, the facilities, the vacant bedroom and the time to speak with the nursing staff to make sure the nursing needs would be met. We spoke with one other person we case tracked who said their relatives found the care home for them and decorated their bedroom before they moved in. We read the care files for the people we case tracked. All contained detailed assessments of care needs completed by the registered manager, who is a qualified registered general nurse, known to people at the matron or the deputy nurse. This was consistent with the information we received from the registered manager before the site visit stating trained senior staff conduct the pre-admission assessment. The assessment covered all aspects of peoples needs from the level of independence, mobility, nursing need, medication, falls, continence, cognitive and sensory impairment to mental wellbeing. There was information recorded about peoples preferences such as food, routines and family, which promotes their wellbeing. The deputy nurse told us she or the matron goes out to meet with the person, to assess the prospective residents care and nursing needs. They told us they get as much information from them, the relatives in some instances and staff such as the hospital staff, District Nurses or the General Practitioner, to ensure the nursing needs are clear and the home is able to meet the persons care needs. Two people, of which one was a relative, told us the matron visited them at the hospital to discuss their care needs and the equipment that is needed such as special mattress that prevents people from developing pressure sores. This demonstrated people were involved in the assessment process to ensure the move to the home is seamless. The comments we received in the surveys from the people living at Kingsley Nursing Home included: We were waiting a long time for a placement somewhere. In the end it was very rushed with just a brief look at the home 2 days before moving in We looked at a few homes and felt that this was by far the most suitable and superior and we have been very pleased with the care not only my mum has received by also my elderly father who visits regularly Care Homes for Older People Page 13 of 39 Evidence: We were shown round by a very friendly helpful member of staff and all questions answered Comprehensive tour was given and in depth explanation of running of the home The nursing assistants told us they receive good information from the nurse in charge or the matron. The staff surveys responses and comments indicated staff receive good information about peoples care needs and the system of sharing information between staff is good. The comments included: We communicate well verbally and written at handover during shift, use of diary and communication book to remind us of important dates I believe we provide a homely atmosphere for our clients. We are very good at assessing or meeting nutritional needs and wound care. I like to think that we build up therapeutic relationships with out clients and their families. Kingsley Nursing Home does not provide intermediate care. Care Homes for Older People Page 14 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well cared for having their health, nursing and care needs met by trained staff that promotes their wellbeing. Evidence: The information we received from the registered manager before the site visit stated residents are supported to make decisions, their wishes are respected, care needs are provided through a multi-disciplinary team approach and have person centred care plans that are reviewed regularly. We read the care plans for the people we case tracked and found these to be comprehensive, personalised in relation to the individual nursing needs and gave clear directions for staff to follow. The care plans included the safety measures identified from the assessment of risks ranging from falls, nutrition, moving and handling and regular turning to prevent pressure sores. The registered nurse told us continence assessments are done by the designated continence nurse and ensure any special equipment that is required is in place, either before the person moves to the home or as soon as it is identified as a need to avoid any risks to the person. Care Homes for Older People Page 15 of 39 Evidence: The registered manager told us they have completed individual evacuation plan for people following the recommendation from the Fire & Rescue Service, which were found in the individual care files. This demonstrated the good practice recommendations made are positively acted upon to benefit the people living at Kingsley Nursing Home. We spoke with the people we case tracked and their visiting relatives. Some people who were able to express themselves indicated they were involved the developing the care plans and the monthly reviews. The records viewed and the survey responses received further demonstrated people are consulted about how their care and nursing needs are met safely. This supported the information we received from the registered manager before the site visit, which stated residents and relatives are involved in care planning. The staff we spoke with both the registered nurse and the nursing assistants demonstrated a good understanding of peoples care and nursing needs. Staff were familiar with peoples routines, giving examples of how some people communicate, express what they want or respond to questions. This showed staff had developed a good understanding of people and their routines, which promotes their wellbeing. The care files we read showed record of visits made by health care professionals from the General Practitioner, Optician, Tissue Viability Nurse, Dietician and Chiropodist. One person we spoke with told us they had new reading glasses. This indicated people were having regular health checks. The records relating to peoples health and wellbeing were well documented and up to date ranging from the daily reports to visits and treatment from the general practitioner. The visiting relative told us they had been impressed by the speed by which the special bed and the air mattress was in place. This demonstrated there was good communication and record keeping. We spoke with the visiting Physiotherapist who was doing activities with a number of people in the dining room. They told us they this was there third visit to the home and had no concerns about the wellbeing of the people living at the home. The comments received from the Physiotherapist included: Had observed a good quality of care, offered staff advice if requested, found the residents were well presented, clean and staff responded quickly to residents Theres a buoyancy in the home and it shows on the patients faces, which is reflective from staff. Care Homes for Older People Page 16 of 39 Evidence: Very good care and likeness of staff I think the level of care is good and Ive not had to intervene Ive observed good bonding and interaction between the patients and staff Ive got absolutely no concerns. The comments we received directly and through the surveys included: Since moving in my mother has received B12 injections on time, the doctor has been called out as she was being sick after meals and as staff were concerned about her eyesight she as had her eyes tested Good care, good food and good staff The registered nurses are responsible for administering medication. The medication is stored in the locked treatment room. We spoke with the registered nurse on duty about the management of medication, who is responsible for the ordering, recording, administering and returning medication. The system for managing medications described by the registered nurse was consistently supported by the record keeping. We checked the medication and medication records for the people we case tracked and found these to be correctly maintained. The medication records also include the persons photograph, any known allergies and the details of the general practitioner. Three people we spoke with including a visiting relative confirmed medication is given timely and was well managed. The registered nurse confirmed nobody was on controlled medication and described the system of administering and recording of controlled medication, which is in line with the regulation. The registered nurse contacted the Pharmacist and confirmed the controlled medication storage meets the new regulation. The registered nurse told us they maintain their skills and validate their status as a registered nurse through regular training and updates. The nursing assistants spoken with said they had access to regular training and benefit from working with trained nurses. The staff training records viewed confirmed all staff receive regular training to be able to meet peoples care and nursing needs. Training certificates viewed in the staff files and the training log maintained by the registered manager showed staff had received training ranging from induction, moving and handling, dementia awareness, prevention barrier control, to the safe use of hoists. The registered nurse told us she had completed training in venepuncture, (taking blood and blood tests) at the home. This demonstrated people are looked after by staff that are trained and receive regular Care Homes for Older People Page 17 of 39 Evidence: training. The responses received in the staff surveys indicated training was regular and good. Other comments received included: We have good working relationships with our GPs, MDT, experts in different fields. I feel that I can access any specialist knowledge I may need i.e. tissue viability nurse. We also have regular contact with local churches There is a very positive and inclusive culture at Kingsley, handovers include input from care staff to inform RGNs to enable holistic planning. Care plans are comprehensive and up to date , staff communication book aids passing information between shifts. As a nurse, I have regularly received information from the whole multidisciplinary team including domestics, cook, owners, matron etc, which help me plan my care process. Training, support for carers and support for clients I believe we provide a homely atmosphere for our clients. We are very good at assessing or meeting nutritional needs and wound care. I like to think that we build up therapeutic relationships with our clients and their families Throughout the day we observed staff treating people with respect and responding quickly when required. We saw staff being sensitive and gentle, helping one person to sit upright by propping a cushion in a more comfortable position and wiping another persons mouth so that their dignity was respected. A relative told us they had always seen staff knock in the bedroom door even if the door was open, addressing people by their preferred name and showed people respect. This supported the responses and comments in the surveys received, which included: Always friendly and helpful, however busy they might be All the staff are always helpful and understanding The nursing staff are very good and positive when dealing with my mothers needs The information we received from the registered manager before the site visit identified areas for improvement, which included promoting end of life care using a multi-disciplinary approach, research by Liverpool Care Pathway and the Gold Standard. The registered manager that she had identified training in end of life care, in the new year. This demonstrated the home continues to look at improving the quality and the range of care to the people living at Kingsley Nursing Home. Care Homes for Older People Page 18 of 39 Care Homes for Older People Page 19 of 39 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social and leisure interests are supported, are encouraged to make choices, are respected and offered a good choice of meals. Evidence: The information we received from the registered manager before the site visit stated the home has strong links with the community who are involved in activities, especially the local church; weekly activity plan is displayed and the homes newsletter gives people advance notice of the months social activities. During the site visit we saw the weekly activity plan displayed on the notice board and photographs of social events that had taken place at the home. There was information for people about the local services including Church services. This showed the information we received was correct and people were offered contact with the local community and social activities. We spoke with a number of people living at the home who said they could choose to join in the activities if they wish to. We saw a number of people receiving visitors at various times during the site visit that indicated visitors were welcome at any time. One person told us they enjoyed reading but had not read since having new glasses and said I prefer to watch the autumn leaves, people walking and the children playing Care Homes for Older People Page 20 of 39 Evidence: football on the park. One relative who visits daily said they had always found the atmosphere warm, relaxed and staff were friendly. The care files we read for the four people we case tracked had their preferences and interests recorded. The registered manager told us they have supported people to make contact and maintain links with family, locally, in the UK and abroad. This demonstrated people were supported to continue having contact with family, friends and were encouraged to socialise and join in activities. We spoke with the visiting Physiotherapist who was doing some exercises with a number of people in the dining room. We saw people choosing to join in the activity with their visiting relatives, they were smiling, laughing and appeared to be enjoying themselves. We saw staff spending time talking with people who were being cared for in bed, which showed people were not excluded from having social contact. A number of staff sat with people in the lounge, and heard talking about peoples appearances, dress to show their country of origin. The conversations were light hearted and the majority of people appeared to have something to say. Staff we spoke with told us they often have pottery, music to movements, hairdressing, film shows and creative afternoons where they have done a collage and some women enjoy having their nails painted. Staff confirmed the priest visits two people at the home although they may go to church of their choice with their family. The registered manager showed us the newsletter that is produced on a monthly basis for people, their relatives and staff, which included new people to the home, social events such as Halloween, focus on a resident, which is done with permission such as birthdays and in memory of people that had died. The registered manager and deputy nurse had recently attended a course on activities, which resulted in the introduction of the film shows and crafting. The information we gathered during the site visit showed the home has been creative in sharing and communicating events and information about the home to the people that live there, their family and staff. We observed staff treating people with respect, supporting them to make choices in how they choose to spend the day. We saw a member of staff walk away when one person said they did not want any assistance from them but was happy for another member of staff to help them. Two people and a visiting relative said they were happy with how the staff treated them, felt they were kind, helpful and listened. This was supported by the responses received in the surveys, which stated staff listened and acted on what they say and staff are available when needed. The comments we received in the surveys indicated the home has a range of activities that people can choose to take part in. Other comments received included: Care Homes for Older People Page 21 of 39 Evidence: The staff usually organise the activities and the residents seem to enjoy them There is a notice board outside the office showing when the hairdresser and chiropodist will be visiting The chef was preparing beef casserole and a vegetarian option for lunch. The staff told us that special dietary needs are met from vegetarian, non-European meals to diabetic, soft or pureed meals. The care plans identified peoples preferred meals, likes and dislikes, which, time was taken to make people had preferred meals offered to them We observed staff asking people to choose from the menu, assisting people to make a decision in a sensitive manner and without intrusion. Meals were served at the dining table for some and in the lounge for other people. We saw staff assisting a number of people with their meals, from cutting meals up to feeding, which was done in a sensitive manner. One member of staff was seen wiping the persons mouth gently to maintain their dignity. People complimented the meals offered to them and a number of visitors said they thought the meals were appetising. We saw records kept of the food and fluid intake where the nurses had concerns about the persons wellbeing and had involved the general practitioner or the dietician. Other comments we received directly or through the surveys included: Good care, good food and good staff They always look appetising. I only have liquidised food so hard to say. The meals I have seen my mother eating have always looked appetizing although she often has them pureed as she cannot manage a knife and fork and does have to be fed My mother has a good appetite and enjoys her meals Care Homes for Older People Page 22 of 39 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident to complain and are protected by staff recruited and trained in protecting people from harm and abuse. Evidence: We read the complaints procedures, which was displayed on the notice board and included in the information people receive about the home. The complaints procedure clearly set out the process, available in large print and who people should contact if they remain unhappy, such as the home owners, social services and the Commission for Social Care Inspection. The contact details for the local advocacy services are displayed and included, should people choose to seek support and advice independently. Two people we spoke with said they were told about the homes complaints procedure, but felt they did not have to complain but mention any concerns to either the staff or the registered manager. The responses received in the surveys indicated people knew how to complain and were confident to express any concerns directly to the registered manager. This supported the information we received from the registered manager before the site visit. The comments we received from people included: We were told how to complain but so far have not needed to complain about anything. Care Homes for Older People Page 23 of 39 Evidence: Id tell them if things werent right or call my daughter who would tell them. I do feel safe here because the staff are good and caring, it makes a difference. We looked at the complaints log, which showed the home had received six complaints since the last inspection, of which four were upheld. The registered manager said whilst complaints are welcomed and addressed these did not have an impact on practice as the concerns were individual and personal. Staff we spoke with and staff surveys received indicated they would pass any complaints or concerns to the registered manager to deal with unless it was something that could be put right straight away. The Commission for Social Care Inspection has not received any concerns or complaints regarding Kingsley Nursing Home. The information we received from the registered manager stated people are consulted and involved in their care planning. The care files read showed people were involved, having the care and nursing needs met that promoted their wellbeing and safety. People told us they felt safe in the presence of staff and this was evident in the way staff responded quickly and sensitively to requests. We spoke with staff about their knowledge and responsibility in relation to safeguarding issues, which means promoting the wellbeing of people using the service from abuse. The staff showed good awareness of the types of abuse that could occur from the physical abuse to neglect and were confident to report concerns to the registered manager. Staff were confident to report poor or bad practice, using the whistle-blowing procedure, reporting concerns to the registered manager and the Nursing and Midwifery Council where concerns are about a registered nurse. The information we received from the manager confirmed staff had received training in safeguarding procedures, which was supported by the staff comments and the responses in the staff surveys. The staff files we read contained evidence of pre-employment checks such as two written references, criminal records bureau checks, protection of vulnerable adults checks and for registered nurses, valid personal identification number (PIN), with the Nursing and Midwifery Council. The staff training certificates on file indicated staff receive training and supported by the staff surveys responses. The registered manager maintains a log of training undertaken by the staff and ensures refresher training is provided on a regular basis to maintain skills and competencies. This demonstrated the home employs staff that undergo recruitment checks and receive regular training Care Homes for Older People Page 24 of 39 Evidence: to ensure staff skills are maintained with current best practice. The registered manager showed us the record kept for personal allowances held on behalf of the people living at the home. The records showed a clear audit of transactions and balances. This demonstrated peoples money was protected by good systems. Care Homes for Older People Page 25 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and well maintained environment that promotes their wellbeing. Evidence: The information we received from the registered manager before the site visit stated the home is well maintained and homely, passed all the fire regulations, replaced furniture as required and maintain all the equipment. We received confirmation of the annual servicing, testing and maintenance of the equipment in the information provided by the registered manager. We also received information about the improvements made at the home, relating to toilet doors being re-hung for better access, fire evacuation plan for each person living at the home and alco-gels place in the hallway to encourage visitors to us on entering and leaving the home. This demonstrated the home continues to make improvements. There are steps at the entrance to the home. The registered manager showed us the portable ramps that are put in place for people using a wheelchair or the emergency service, better access to the home. Kingsley Nursing Home has a warm and friendly atmosphere having decor and furnishing of domestic character that creates a homely feel. The rooms were bright, benefiting from ample light through the windows and well lit corridors. We saw people Care Homes for Older People Page 26 of 39 Evidence: sitting the a number of small lounges and dining rooms, that allowed people to make choices according to where they wish to spend their time. Some people sitting in the dining room enjoyed a group activity with the physiotherapist, whilst other people were being cared for in bed. With permission the registered manager showed us a number of bedrooms. All the bedrooms were spacious, having sufficient space for equipment like hoists. The shared bedroom view ensured peoples privacy with privacy screen available. The bathrooms and toilets are clean and spacious and people benefit from having a parker bath for people with mobility difficulties. The bedrooms were personalised with photographs, ornaments and fresh flowers and plants. Some people who were nursed in bed were provided with special pressure air mattresses and staff were seen regularly checking and turning people, to prevent skin break down and pressure sores from developing. The nurse care plans we read reflected the specialist equipment in use, risk assessments and clear guidance for staff to follow. This demonstrated the home uses special equipment where required and have staff following the nurse care plans to promote peoples health and wellbeing. People told us they felt the home was clean and the survey responses consistently stated the home was fresh and clean. A visitor told us that they had found the home was always clean and felt their relatives bedroom was kept clean at all times, as they were being nurse in bed. The relative said they had all the equipment in place before .... moved here, the special bed, the special chair and the bedroom was made up. We saw people moving around the home, independently, with the use of a walking stick or with the assistance of staff. One person said their bedroom is upstairs and use the passenger lift with a member of staff when they wish to go to their bedroom. We saw staff wearing protective gloves and aprons when preparing to assist people with personal care tasks, or handling meals at lunch time. There were ample supply of gloves and aprons around the home for staff to easily use them when required. We saw the domestic staff cleaning the home, individual bedrooms, communal areas and some staff collecting peoples laundry. The registered nurse showed us and described the system in place for the disposal of clinical waste, sharps and medication returns and records retained to support this. Staff we spoke with said they always have a good supply of protective clothing and demonstrated awareness of health, safety, infection control procedures that are in use and said they benefited from having trained nurses that acted quickly when concerns were raised. We saw the training certificates in the staff files including food hygiene, health and safety, infection control and trained nurse maintaining their skills through accessing training at the local hospital. This demonstrated the information we received Care Homes for Older People Page 27 of 39 Evidence: from the registered manager before the site visit, supported the majority of the survey responses and our findings during the site visit. The comments we received about the home environment were shared with the registered manager, who was made aware of a comment expressing some concerns about a specific bedroom having odour and stained carpets. The registered manager immediately responded positively to the concern and said they were aware of the issue, were having the carpets cleaned and had discussion with the individual and their relatives with regarding to the floor covering. Other comments received included: The home and the surrounding garden are clean and pleasant I am comfortable, secure and safe in my home I am very happy with the home, they are always helpful Care Homes for Older People Page 28 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by good staff recruitment processes and training that ensures peoples nursing care needs are met that promotes their independence and wellbeing. Evidence: We survey responses we received indicated staff were always available, listened and acted on what people said. The comments we received in the surveys were: Very caring staff We feel the staff are at times stretched to deal with everything required bearing in mind the other residents All the staff are always helpful and understanding The nursing staff are very good and positive when dealing with my mothers needs Staff are always available to talk to visitors and have never needed to complain about any aspect of my mums care The staff are dedicated to their tasks Care Homes for Older People Page 29 of 39 Evidence: The staff are very courteous First class staff The staff team is led by the registered nurse and four nursing assistance during the day, to meet the needs of the people living at the home, which was reflected in the staff rota. We spoke with the registered nurse and a number of nursing assistants, all felt comfortable with the level of staffing that met peoples nursing care needs. The registered nurse told us they mentors a student nurse and is responsible for the training and assessment. This demonstrated that registered nurse maintains both her nursing skills with current practice and mentoring skills to ensure the student nurse recognise and value the needs of people rather than looking at treating the illness or disability. The information we received from the registered manager before the site visit stated the home recruits in a fair and open way, carry our all required checks on prospective staff and nurses are registered with NMC. We spoke with the registered nurse and a number of nursing assistants including the newest member of staff. They described the recruitment process and confirmed they had to wait for checks with the criminal records bureau check. This was consistent with the information we received from the registered manager before the site visit and staff survey responses. We looked at the four staff recruitment files, all contained records of references, criminal records bureau (crb) checks, protection of vulnerable adults (pova) checks and for nurse, confirmation of their valid personal identification number (PIN) with the the Nursing and Midwifery Council. Staff confirmed they completed induction training and worked alongside experienced staff and nurse, having completed training in moving and handling, health and safety, safe use of hoists and safeguarding. The senior nursing assistant told us they had benefited learning about wound care, pressure area care and practice, having worked alongside the registered nurse. This demonstrated that nursing assistants were learning about nursing care, that improved their own practice to promote peoples wellbeing. The registered nurse confirmed they are responsible for maintaining their own skills base and registration and have accessed training through the local hospital. The training they had completed recently included: venepuncture (taking blood) and mentor coach training to support the student nurse. Comments received in the staff survey: I have received training and updates since I have been here. This includes external Care Homes for Older People Page 30 of 39 Evidence: course and in-house training . Covered a range of topics from dementia, challenging behaviors, Parkinson, ethnic aspects, quality of care, bereavement, counseling, venepuncture and wound care I am new in post and as yet have not been on training courses. However, my manager is very pro-active about training and together we have identified and booked courses, which will be a benefit in my role. 3 days paid training is very useful The registered manager maintains the record of the staff training in a book and confirmed 72 of staff had attained the national vocational qualification level 2 and above in care. The registered manager told us that they are having to identify training courses since the training officer left such as palliative care and having accessed information for staff through various educational and training organisations. The staff surveys indicated they meet with their manager on a regular basis, consistent with what the staff told us on the day. We saw the supervisions agreement in place in the four staff files we looked at, demonstrating the formal management process. We read the minutes of the staff team meeting displayed on the notice board for staff to read. Staff told us they have handover meetings at the change of shifts, which was consisted with the responses we received in the staff surveys, demonstrating there is a good system of communication between staff. We also received the following comments in the staff surveys: We have handover at the beginning of the new shift, we also write information in the care plans and update regularly. Also give and receive feedback during shifts Nobody is allowed to start work until they have new crb checks and pova clearance. Each new member of staff is then monitored Regular supervisions, appraisals also open door policy to have information discussion if needed We communicate well verbally, and written, at handover during shift, use of diary and communication book to remind us of important dates. Also often ring matron to discuss important topics We have a good staff/client ratio. We have never had to use agency staff, if somebody is ill, we cover each others shifts. Good working relationships with each other There is a very positive and inclusive culture at Kingsley, handovers include input Care Homes for Older People Page 31 of 39 Evidence: from care staff to inform RGNs to enable holistic planning. Care plans are comprehensive and up to date, staff communication book aids passing information between shifts. As a nurse, I have regularly received information from the whole multidisciplinary team including domestics, cook, owners, matron etc, which helps me plan my care process I was consulted on my needs prior to the induction and my needs were included in the induction. I felt well prepared to be in charge of the shift and my manager provided discreet support. Care Homes for Older People Page 32 of 39 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a well managed home, express their views about the quality of care they receive that promotes their health, safety and wellbeing. Evidence: The registered manager recently successfully completed the registration process with the Commission for Social Care Inspection deemed to be a fit person to manage Kingsley Nursing Home. The registered manager is also a qualified trained general nurse, having a valid registration with the Nursing and Midwifery Council. People living at the home, visiting relatives and staff felt the registered manager, known as matron, was very approachable. The registered nurse on duty confirmed there is always a trained nurse on duty and four nursing care assistants during the day to meet peoples nursing care needs. The staff told us about their individual roles and responsibilities, which demonstrated clear management and staffing structure is in place to meeting peoples needs. Staff told us Care Homes for Older People Page 33 of 39 Evidence: they felt supported and were confident with the instructions and guidance given by the nurses, which was consistent with the responses received in the staff surveys. We read the minutes of the last residents meetings held on 9th October 2008, stating the topics discussed such as the Halloween party. We read the monthly homes newsletter produced by the registered manager. It had information about new residents, new staff, planned social events, a focus on a resident, with permission and information that would be of use to people. We saw peoples nursing care plans were reviewed monthly or more often as peoples care needs changed. The registered manager told us that she had conducted staff surveys and the cook did a survey to gather peoples views about the meals. This showed people were informed and consulted individually to ensure their needs are met, have an opportunity to comment on the care and the meals provided. The registered manager told us and showed us the records of the monthly quality checks carried out on the home. This showed there were systems in place for checks and monitoring of the home. However, the registered manager was unable to demonstrate how the results from all the checks, surveys and views gathered including any feedback from the student nurses was consolidated on an annual basis and what areas of improvements were identified. The registered manager accepted the comments, recognised the need to understand the results and provide people with some feedback to show their contributions has been valued. We saw the compliments received by the home in the form of cards and letters. This demonstrated people recognised and appreciated the quality of care provided at the home. The information we received from the registered manager before the site visit stated there is safe storage of valuables and money and some people are supported by their family or appoint a power of attorney. The people we case tracked were unable to tell us what support arrangement is in place to help them manage their money. The registered manager described the procedure, which trained nurses are responsible for and showed the financial record keeping for the money held on peoples behalf. The records were clear and auditable, which showed peoples money is protected by good systems in place. The information we received from the registered manager before the site visit stated the policies and procedures are in place, reviewed and updated. The staff surveys responses and from discussion with staff, they said they were kept up to date with changes through team meetings and confident to approach the registered manager or the registered nurses at any time. This showed information is communicated to the Care Homes for Older People Page 34 of 39 Evidence: staff to ensure their follow the new guidance and procedures. Staff told us they had regular supervision meetings with the manager. This was supported by the staff survey responses and evidence of the supervision agreements in the staff files, as the record of the meetings are confidential. We also read the minutes of the last staff team meeting, which demonstrated staff are kept up to date with changes and developments that affect them, the people living at the home and the management of the service. We asked to see the reports from the monthly visits carried out by the registered individual, presented by the owners of the home. The registered manager told us that the monthly visits had been done but she had never received a copy of the report detailing the findings and areas of improvement. We discussed the value of receiving feedback and records that show the responsible individual is fulfilling their responsibility. We saw the assessments of risk carried out with people as part of the assessment and admission process and where risks have been identified subsequently. The risk assessments were in place for moving and handling, use of lap belt, falls, pressure area care and use of cot sides. The assessments were reviewed monthly and the safety measures to be used were detailed in the nursing care plans for staff to follow, such as timely turning where the person is being nursed in bed, monitoring the intake on food and fluid and having two staff to assist with any moving, handling and transfers. The staff training records showed the registered nurse had been trained in assessing risk and training completed by other staff included health and safety and fire training. The information we received from the registered manager before the site visit detailed the programme of maintenance, servicing, testing of equipment and checks that are in place. The registered manager confirmed she carries out routine safety checks monthly and reports maintenance concerns to the joint responsible individual and owner of the home. From our observations made of the home during the site visit, it was evident that the maintenance of the home has the same priorities as the quality of care people receive. Some of the comments we received directly from people, visitors, staff and through surveys included: When I or my brothers have made requests on my mothers behalf, the staff have acted positively Having spoke with other people in a similar position we understand Kingsley to be one of the better homes of this type Care Homes for Older People Page 35 of 39 Evidence: Theres a buoyancy in the home and it shows on the patients faces,w which is reflective from staff. I believe we provide a homely atmosphere for our clients. We are very good at assessing or meeting nutritional needs and wound care. I like to think that we build up therapeutic relationships with our clients and their families The service takes a pro-active approach to the care of the residents, thinking ahead about their needs, rather than simply being reactive. The manager is a very strong leaver, very approachable and supportive and open to new ideas. There is a happy feel to the environment and all staff have an excellent knowledge about the residents, including their likes and dislikes. Communication between all levels of staff is good. Care Homes for Older People Page 36 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 37 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 33 The report of the monthly visits carried out by the responsible individual or their representatives, should be made available at the home. The quality assurances systems in place and the results of these should be analysed, used to develop an action plan and shared with the people living at the home and other stakeholders that have contributed. 2 33 Care Homes for Older People Page 38 of 39 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 39 of 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!