CARE HOMES FOR OLDER PEOPLE
Kingsley Nursing Home 4 Trafalgar Road Southport Merseyside PR8 2EA Lead Inspector
Claire Lee Unannounced 26th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Kingsley Nursing Home Address 4 Trafalgar Road Southport Merseyside PR8 2EA 01704 566386 01704 566386 kingsleyhomesltd@yahoo.co.uk Kingsley Nursing Homes Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 25 Category(ies) of OP Old age 25 registration, with number of places Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 25 (OP). 2.The service should at all times employ a suitably and qualified experienced manager who is registered with CSCI Date of last inspection 7th December 2004 Brief Description of the Service: Kingsley is a privately run home providing 25 places for older people who require nursing care. The registered provider/owner is Kingsley Nurisng Homes Ltd. The home is currently without a registered manager however Mrs Barbara Evans has been appointed by the owners and she is in the process of applying to the Commission for this position. Kingsley is situated in a residential area of Southport with easy access to local shops, the town centre and public transport. The premises are detached and comprise of 2 buildings over 4 floors. The home has 21 single bedrooms (4 with ensuite) and 2 double bedrooms both ensuite. The accommodation is on the ground, first and second floor and a passenger lift provides access to all areas. Residents have access to a call stystem with an alarm facility. Recrational space consists of a lounge and dining room overlooking the front. Bathrooms although domestic in style have aids to assist those who are less independent. The home has well established gardens to the front and rear and there is some car parking space. A ramp leads to the front door. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 8 hours. It was an unannounced visit and was carried out as part of the regulatory requirement for care homes to be inspected at least twice a year. A visit was conducted earlier this year to follow up requirements from the previous inspection in December 2004. During this visit a partial tour of the home was conducted. Care, staff and other nursing home records were inspected. The inspector met with the manager, a registered nurse, 2 staff, 5 residents and 2 relatives. Comment cards were left for residents and relatives to complete regarding the service and facilities provided at the home. The inspection was very positive and the home have done well in meeting the requirements from the last inspection. The home is settling down under the new manager’s guidance and leadership and staff were seen working as an enthusiastic and committed team. What the service does well:
Kingsley provides a warm welcoming atmosphere for residents and relatives. The home has a friendly feel to it and staff ensure the residents receive a good standard of care. A resident said, “the staff are just lovely, they are busy but have time for a chat.” The manager conducts the initial assessment with the resident and family member. The assessment process is detailed to ensure residents are correctly placed at the home. A resident who has recently arrived said he was settling in well and staff were supportive. Residents have an individual plan of care, which includes key areas, for example, mobility, washing and dressing, nutrition and skin condition. Specific health needs are also monitored by staff and recorded in detail in the plan of care. Residents commented on the respectful attitude of staff and stated that assistance with personal care was given in an unhurried manner. Communication between residents ands staff was seen to be good and staff were on hand to help residents where needed. The staffing level in the home is consistent with no use of agency cover. Staff receive regular supervision.
Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 6 The owners provide very good written reports on the home and these are forwarded to the Commission on a monthly basis. Residents have recently completed satisfaction questionnaires and comments received have generally been favourable regarding the service and facilities in the home. Mrs Evans has spent time with residents discussing suggestions and ideas. What has improved since the last inspection?
As previously stated the home has worked hard to comply with the requirements from the last inspection. This was good to see and residents and staff spoke enthusiastically about the recent changes made. Residents feel the home is well managed. Residents are admitted to the home following a full assessment and the assessment process now covers specific needs relating to nursing care and medical conditions. All residents have a plan of care, which is reviewed on a regular basis to ensure the information is kept up to date. The resident’s agreement to their plan of care is also being sought and recorded. Quantities of medicines received in the building are now recorded and staff signatures were evident for medicines administered. The home has a policy for residents who wish to self medicate. The home has a policy regarding residents’ monies and financial affairs and precludes staff involvement in the making of or benefiting from residents’ wills. A plan for decoration of the home was available and rooms are being decorated when vacated. Height adjustable beds are being purchased and residents are asked whether they would like a lockable facility for the safe keeping of their money and valuables. These are provided on request. When recruiting staff, job application forms are completed regarding past employment and 2 references are sought before commencing work. Staff are also now asked to complete a health declaration form as part of the recruitment process. New staff receive induction during the first six weeks of employment and manual handling and fire prevention training has been given. Staff receive formal supervision on a regular basis. General records and care records viewed were up to date and well maintained. This included fire prevention records. The fire service conducted a visit to the home earlier this year for general advice and doors were checked to ensure they shut to their rebate.
Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 There was a good standard of assessments enabling the home to be sure of meeting residents’ care needs. EVIDENCE: Individual records are kept for each resident and the manager completes the assessment documentation prior to admission. Several resident assessments were seen and these included an assessment that had been completed with the assistance of hospital staff as the resident was unable to provide the necessary information. Care management assessments from social services were also on file as well as evidence of the home’s own assessment format. Details of individual needs were transferred over to care plans in all cases. The manager is looking to change the assessment documentation over the next few months to ensure more detail is recorded for ‘the reason for admission’. This will further assist when drawing up the plan of care. A relative stated that the admission procedure to the home had been organised and staff were providing a good level of care and support to the family.
Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 It was clear that that the health, personal and social care needs of residents were understood and set out in an individual plan of care. Medication practice was according to the home’s policy and procedure. Care was provided sensitively, residents were treated with respect to maintain their privacy and dignity. EVIDENCE: Individual plans of care were available and improvements have been made to ensure that all aspects of health, personal and social care needs are identified and planned for. Care plans viewed evidenced key areas, for example, family involvement, diet, mobility, skin care and personal hygiene. Staff interviewed demonstrated a good understanding of these needs and described the care they were giving. Care plans viewed were detailed, easy to read and had been reviewed monthly to ensure they were accurate and up to date. A number of care files evidenced agreement by the resident and/or relative to their plan of care. A resident interviewed spoke positively about the nice nature of the staff when being helped with washing and dressing. Supporting care documentation
Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 11 included a waterlow score (a tool for assessing pressure area care), risk assessments and manual handling instruction. Residents are weighed and nutritional assessments completed. Wound care is recorded and wound care charts include diagrams of the affected site. Records viewed indicated advice from the Tissue Viability Nurse regarding wound care management. Residents confirmed that they are referred for hospital appointments and can see their own GP at any time. A GP was visiting at the time of the inspection and staff acted promptly arranging admission for a resident to hospital. A staff member accompanied the resident. Another resident is attending hospital as an outpatient and care records evidenced the treatment given. A resident who underwent eye surgery was having her care plan updated to ensure staff were aware of her postoperative care and follow up appointment. Residents receive their medication from blister packs. A number of medicine sheets were reviewed these evidenced staff signatures following administration. Residents are able to self medicate if they wish and sign a disclaimer for this purpose. This was discussed in relation to eye drops and the home should regularly risk assess this practice with the resident and incorporate the information in the care plan. Residents were complimentary regarding the polite and helpful attitude of staff. Comments included, “the staff are very nice” and “the staff have time to talk with me and take their time when they are with me.” Residents’ preferred name is recorded in their plan of care and residents were smartly dressed. Staff were observed to knock on bedroom doors before entering and also offering residents assistance with their lunch in an unhurried manner. Residents thought the key worker system involving named care staff was a good idea. Staff also confirmed that they are enjoying this role as they are getting to know the residents better. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 The home has a relaxed routine and daily life in the home is based round residents’ wishes and needs. Visitors are welcome at any time. Meal times are a sociable occasion and the menu offers a good choice of nutritious well-balanced meals. EVIDENCE: There was a friendly atmosphere in the home and residents were sitting in the lounge and very much enjoying singing and guitar playing by a gentleman who provides musical entertainment each month. Visitors were seen popping in and meeting residents in the lounge and in their bedrooms. A relative said, “the staff never mind what time we come in.” Residents interviewed discussed their daily routine and how staff accommodate their time of getting up or retiring at night. A resident said, “the staff ask what time I want to go to bed and there is never a problem if I want to stay up late”. Several residents have the use of a small fridge in their room also a toaster and kettle, which they requested. Some residents prefer not to come to the lounge or dining room and staff respect their wish. The home is developing more activities and social interests for the residents, flower arranging is still popular for the ladies and the home has a good supply
Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 13 of ‘old’ films and music. A make up demonstration and head massage is planned later this month. Manicures are also given. Social interests are recorded and families encouraged to take part in social events. Overall, residents spoken with confirmed they were satisfied with the activities and said, “there is more going on now in the home.” A new television has been purchased for the lounge. The menu was seen and this is based over a 2-week period. The menu evidenced a hot meal at lunchtime however a further choice is available. This should also be stated on the menu. Residents confirmed that they are asked what they would like to eat and generally the food is of a good standard. The main meal of the day is served at lunchtime with a lighter meal in evening. Fresh fruit was available in the lounge. Residents are served meals in the dining room or in their own rooms if preferred. Serving trays were noted as being old and some are marked. They do not look attractive and spoil the presentation of the meals. Consideration should be given to purchasing new ones. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints have been handled fairly and promptly. Residents and relatives were confident that if they needed to make a complaint this would be listened to and acted upon. Safeguards were in place to protect residents from abuse. EVIDENCE: The home has not received any complaints since the last inspection however staff confirmed that they would know what to do should a complaint arise. A relative stated that the manager had addressed some initial ‘teething problems’ and did not have any issues now. Everything had been resolved. Abuse awareness is discussed during staff induction though no formal training has been given. This must be arranged over the next 6 months. Policies and procedures are in place to protect residents and staff have access to a whistle blowing policy. A member of the care staff discussed the various forms of abuse and how she would report any suspicion to the manager. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 General improvement are being made to the environment to ensure residents benefit from safe, ‘homely’ and comfortable surroundings. The home was clean and hygienic. EVIDENCE: Kingsley is situated over 4 floors and is spacious, airy and warm. The home now has a programme of decoration and refurbishment. The lounge and dining room/conservatory have been redecorated and bedrooms are receiving the same treatment when vacated.” This programme should continue, as there are some rooms that still require attention and many pieces of furniture are old and should be replaced over a period of time. The environment will be inspected in full at the next inspection. The home’s handyman carries out general maintenance and the repair of a dressing table was brought to the manager’s attention. Bathrooms are domestic in style and will in time need some work as bathrooms suites are old and working space is limited. Staff confirmed that the bathrooms are difficult to work in. A resident commented on the home having a nice ‘homely’ feel to it and being generally pleased with
Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 16 her bedroom. The home has a garden to the front and rear and there is also some car parking space. The external grounds are kept in good order. Residents spoke favourable regarding the laundry service and stated that clothes are returned promptly. Staff have access to infection control policies and the home employs sufficient domestic staff to keep the home clean and tidy. This was evident at the time of the inspection. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Sufficient staff were on duty to meet the needs of the residents. Training for staff is still required in certain areas to ensure competency in their role. The procedures for the recruitment of staff do not include necessary Protection of Vulnerable Adult (POVA) checks prior to employment on all staff, which are needed to help ensure protection to people living in the home. EVIDENCE: Inspection of the staffing rota and direct observation confirmed that sufficient staff were present throughout the day. A registered nurse was on duty with 4 care staff during the morning and afternoon. Ancillary staff included a cook, kitchen assistant and 2 domestics. At night the home employs a registered nurse and 2 care staff. Staff stated that staffing levels over the last few months had been affected by staff leaving and holidays however this had now improved. There are currently no staff vacancies. Staff meetings are held and minutes available. A new member of staff has been employed following the last inspection and one member of staff is being recruited. Recruitment records showed that this member of staff had not received a clearance from the Protection of Vulnerable Adults (POVA) register, which is a requirement prior to employment in order to protect residents from known abusers. This needs to be addressed in all cases of future staff employment. The job application form viewed had been
Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 18 completed in detail regarding past employment and 2 written references received. The references had been faxed through and were dated and signed. Consideration should however be given to requesting the original document. Staff receive job descriptions and are given terms and condition of employment. New staff now receive a full induction and also attend a full day induction course with an external company. Staff have received manual handling and fire prevention training however first aid, food hygiene and infection control/health and safety is still required. This must be given over the next 6 months. Courses for eye care and wound care management have been attended ‘in house’. Training files have been developed and these evidence course details and some certificates. Residents and relatives were complimentary regarding the staff and their cheerful attitude. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 General records of the home viewed including fire prevention and accident records were up to date to promote and protect the health, safety and welfare of the residents. EVIDENCE: Fire prevention equipment is subject to a full safety check and maintenance contract. The last inspection was conducted in February 2005. Staff also confirmed that they had received fire prevention training and this is next due in August 2005. Fire alarms are checked weekly by the home however it is recommended that the emergency lighting be also checked monthly ‘in house’. The fire service conducted an audit of the building in June 2005 and a fire drill was also conducted during that month. Any requirements or recommendations following the visit have been actioned. Accidents to residents and staff were recorded and the information stored in line with guidance regarding data protection.
Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 20 The owner undertakes a monthly visit of the home to audit the service provided and a detailed report is forwarded monthly to the Commission in line with Regulation 37 of the Care Standards Act. Standard 31 and 32 were not inspected on this occasion as Mrs Evans has yet to be registered as the manager. Her application with the Commission is being processed. Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x 3 Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 18 29 Regulation 18 19 Requirement To provide abuse awareness training for staff All staff must recive a POVA first check and clearence prior to commencing employment in the home. To provide training for staff in safe working practice areas Timescale for action 1.2.06 Ongoing 3. 30 18 1.2.06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 9 15 19 27 38 Good Practice Recommendations To compete a plan of care for residents who wish to self medicate and risk assess this practice on a regular basis To include the choice of meal at lunch time on the menu and to purchase new serving trays for residents meals To continue with a programme of redeocration and refubishment. To mend the broken dressing table Faxed references to be followed up with the orginial reference To undertake monthly checks of the emergency lighting Kingsley Nursing Home F53 F03 S44817 Kingsley NH V226641 260705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Burlington House, South Wing 2nd Floor, Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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