CARE HOMES FOR OLDER PEOPLE
Kingsley Nursing Home 18/20 Kingsley Road Northampton Northants NN2 7BL Lead Inspector
Irene Miller Unannounced Inspection 3rd October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kingsley Nursing Home Address 18/20 Kingsley Road Northampton Northants NN2 7BL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01604 712411 01604 711199 Carehome32@aol.com Hollyberry Care Limited Mrs Linda Frances Kench Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25), Terminally ill over 65 years of age (25) Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection New Registration Brief Description of the Service: Kingsley Nursing Home is a private nursing home and is registered to accommodate up to 25 older people, within the categories of registration Kingsley Nursing Home can provide care for people living with dementia-related 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 six single bedrooms with en-suite facilities and nine shared bedrooms without en-suite facilities. 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. Fees range from £465.00 to £500.00 per week. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This inspection was a ‘Key Inspection’ that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. Prior to the inspection taking place the Commission for Social Care Inspection sent out to the home a pre-inspection questionnaire for completion by the Registered Manager. A sample of residents where selected to receive comment cards for completion, and the home was sent a sufficient number of comment cards for distribution to visitors/relatives and general practitioners who have contact with the home. The completed pre-inspection questionnaire was returned to the Commission for Social Care Inspection, nine residents feedback cards and twelve visitors feedback cards, were returned and two feedback cards from general practitioners that have contact with the home. The feedback provided information on the management systems within the home and outlined the general satisfaction of residents living at the home. The primary method of inspection used was ‘case tracking’ that involved selecting three residents, reviewing their individual care plans (that sets out how the home aims to meet their personal, healthcare, social and spiritual needs), and tracking the care they receive through discussion with residents, staff, visitors and the homes management and general observations of care practices. Policies, procedures and records in relation to staff recruitment, complaints, medication and general maintenance and upkeep of the home were viewed. The registered manager Linda Kench was available at the home throughout the inspection, and the registered providers Mrs and Mrs Robinson were also available. The inspector spent two hours planning the areas to focus on at this inspection, based upon information gained from reviewing the homes service history, the last two inspection reports and information from the pre inspection data collection systems. The inspection took place over a period of approximately five and a half hours.
Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
To ensure the residents rights to confidentially is maintained, records of any concerns and complaints made, need to be kept in line with the Data protection act 1998. From the car park at the rear of the building, there was access to the home through a garden gate which led up to the rear of the property the gate was
Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 7 open and upon arrival at the home it was noted that a rear exit fire door was open, and no staff were available within the vicinity. On speaking with the registered manager it was established that some visitors use the fire door at the rear of the building as a means of entering the home, should this be the case, consideration should be given to putting in place additional security measures, as the practice of leaving the door open could compromise the homes security. 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 DS0000067790.V313811.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 is not applicable to this service) Quality in this outcome area is good. Sufficient information about the home is made available to prospective residents, to enable them and their representatives to make an informed choice, on whether the home could meet their needs and expectations This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information was made available to prospective patients and their representatives prior to admission, to include the homes statement of purpose and service users guide, which sets out the homes aims and objectives on the range of services and care that can be provided and the facilities available within the home. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 10 Contracts of residency were in place and had been signed by the residents and where this was not possible by their representatives. The care plans looked at included pre assessment documentation that had identified the level of care required by the resident and how their needs were to be met. Each prospective new resident is invited to visit the home to meet the residents and staff and sample the lifestyle within the home, following admission into the home a settling in period of one month takes place, after which a full review of the care is conducted to ensure that the home can continue meet the needs and the expectations of the new resident. On the day of inspection a prospective resident and their relative where visiting the home, staff were observed to be welcoming and information on the home was provided, such as the homes brochure, statement of purpose and service users guide. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is excellent. The home meets the physical and emotional needs and expectations of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans contained detailed information on the range of physical and emotional needs of residents, the plans were regularly reviewed and updates had been made where any changes in the resident’s health care needs had taken. Staff spoken with were fully aware of the individual health care needs of the residents, there was detailed information on the treatment and prevention of pressure sores, nutritional assessments, fluid intake monitoring and wound management. Many of the patients living at the home require a high input of clinical nursing skills and detailed information was available within the care plans for patients who required this level of care. Information was available on health care
Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 12 monitoring, such as pressure ulcer prevention and management, artificial (PEG) feed systems (Percutanious Endoscopic Gastronomy Feeds). The nursing staff employed at the home hold the responsibility for the administration of residents medication, the staff were observed administering the lunchtime medication and on speaking with the staff it was apparent that they had a thorough knowledge of the needs of the patients in relation to their medication needs and preferences. The medication storage and administration records seen were in good order, and medication that was no longer in use was disposed of through a licensed waste disposal company and records were available to demonstrate this. Staff were observed to care for the residents with compassion and respect and residents spoken with said that the staff did everything they could to help them and that the home is very nice and they felt well cared for. Within the care plans the patients wishes in the event of death were recorded, the home welcomes visits from representatives from the churches within the local community. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. The social, cultural, recreational and occupational expectations of residents are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On speaking with visitors they spoke very highly of the staff and the registered manager (matron) saying they were always made very welcome at the home, comments such as how very lucky they had been to have found such a wonderful home such as Kingsley Nursing Home for their loved ones. There is no restriction to visiting times and this was confirmed by the visitors spoken with, who said that they were particularly impressed with the way that the home encouraged them to remain involved and participate in the day-to-day care of their relative if they so wished. The home welcomes activity specialists in providing therapeutic activities for residents to stimulate the mind and body, in sessions such as music and Movement, physical motivation and reminiscence discussions. On the day of inspection a visiting therapist was at the home conducting a music and movement session with a small group of residents, the therapist
Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 14 was observed to gently gain the attention of the residents in encouraging some small arm and leg movements in time to music that was appropriate for the type of exercise session, the residents were observed to respond very well and appeared to enjoy the activity. The home produces a monthly newsletter for residents and families called ‘In Touch’ the October newsletter covered topics such as fund raising events, thanking those that had participated and supported a tea party and raffle that had taken place, there was a section on historical events of October in years gone by, such as the year when the first ball point pen was produced, when the first nylon stockings were sold in the USA, and the year when the first cancan was performed in Paris! There was dates for your diary informing residents families and friends of up and coming events, there was an article called resident focus that welcomed new residents into the home and with the residents permission gave a little write up on where the resident was born where they lived, their previous occupations, hobbies and interests. Representatives from the local churches visit the home and for residents that wish to receive Holy Communion this is made available. The menus seen contained a variety of meals available and for residents that require vegetarian, pureed or special diets to meet their healthcare or cultural needs this can be accommodated by the home. The kitchen was clean and tidy and systems were in place to prevent cross contamination of foods. The member of staff working within the kitchen had a sound knowledge of the dietary needs and preferences of the residents living at the home. The homes management had sought the advise of a nutritionalist the improve on the quality and presentation of foods for residents that required their foods to be pureed. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 16 & 18 Quality in this outcome area is good. Residents can be assured that any complaints or concerns that they may have will be listened to and acted upon by the provider, however the system for recording complaints or concerns could be improved to ensure residents confidentiality is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is made available to all new residents and their representatives, and there is a copy of the procedure on display within the entrance lobby of the home The home keeps a record of all complaints made, and a record of the actions taken by the homes management to address and resolve them, however on examining the complaints book it was noted that several different complaints had been entered consecutively on the same page, and therefore did not comply with the Data Protection Act 1998. This was discussed with the Registered Manager who agreed that to protect confidentiality each entry should be logged separately. From the comment cards received by the Commission for Social Care inspection one comment in relation to the complaints procedure was made such as “complaints I have made are only of a minor nature & easily solved”.
Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 16 The Commission for Social Care Inspection (CSCI) was satisfied that the home deals with any concerns or complaints raised in accordance with the homes complaints procedure and no complaints about the home had been brought to the attention of (CSCI) since the last inspection visit. The home has a policy on the protection of vulnerable adults and in house training is provided for all staff on recognising what is abuse and how to report any suspected or actual abuse. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19 & 26 Quality in this outcome area is good. Resident live in a home that is clean, comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the car park at the rear of the building, there was access to the home through a garden gate which led up to the rear of the property the gate was open upon arrival at the home and it was noted that a rear exit fire door was open, and no staff were available within the vicinity. On speaking with the registered manager it was established that some visitors use the fire door at the rear of the building as a means of entering the home, should this be the case, consideration should be given to, putting in place additional security measures as the present practice of leaving the door open could compromise the homes security.
Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 18 There was a selection of equipment provided by the home to ensure that the residents needs could be met, such as pressure relieving equipment, wheelchairs, specialist chairs/seating, assisted showers and baths, grab rails, hoists and specialist feeding equipment. A limited tour of the building was conducted and the bedrooms seen were personalised, with items such as personal items of furniture and smaller possessions such as photos, plants and ornaments. Refurbishments had taking place to include some replacement of curtains and bedroom furniture, in general there was a good standard of decoration throughout the home. Bedrooms viewed that had shared accommodation, had privacy screens available. The lighting within some of the corridors was switched off and therefore the quality of the lighting was not good, however it was explained that some residents choose to switch the lighting off, the staff were fully aware of the need for sufficient lighting to be available throughout the home and did there utmost to ensure that this was provided for at all times. The home was clean free from unpleasant odours, and systems were in place for the prevention of cross infection in general there was a high standard of cleanliness throughout the home. Comments received from visitors expressed their satisfaction with the standard of cleanliness in the home “the hygiene is to a very high standard”. Systems were in place for the disposal of clinical waste, sharps, and medication returns, and records were retained by the home. The external of the home appeared well maintained and the garden looked pleasant and was well kept. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is excellent. The staff team are well trained and skilled within their roles ensuring that the needs.of the residents can be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing levels on the day of inspection were sufficient to meet the needs of the current residents. A registered nurse leads each shift, morning and afternoon and at night one registered nurse and two care staff care for residents. There was a high commitment from the homes management towards staff training and the home employs a training co-ordinator who holds a National Vocational Qualification (NVQ) Assessors Award and had recently gained an National Vocational Qualification 3 in Training and development, this position supports the home in ensuring that NVQ training is an on-going process, and assists in the planning and implementation of mandatory and vocational training needs. The training co-ordinator had enthusiasm and was motivated in ensuring that staff were fully supported and trained within their respective roles.
Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 20 The training programme (matrix) was viewed and demonstrated the training that had taken place and training that was planned covering the statutory induction training such as fire safety, moving and handling, health and safety, first aid, food hygiene and adult protection following the skills for care (common induction standards for social care), in addition further training was provided in areas such as dementia care, parkinson’s, diabetes and nutrition for the elderly, and training had been provided from a local funeral directors on funeral awareness. The training co-ordinator had been successful in arranging for numeracy and literacy support for staff that required assistance in gaining more confidence in these areas. Records were available of all training undertaken by each member of staff. For registered nurses employed at the home training was provided to ensure that clinical nursing skills were updated in areas such as wound care and management, and artificial (PEG) feed systems (Percutanious Endoscopic Gastronomy Feeds), and the administration of medication. The home has exceeded the National Minimum Standard ratio of 50 of staff being trained to National Vocational Qualification level 2 by 2005. Staff recruitment files looked at evidenced that robust staff recruitment procedures were followed that included Criminal Records Bureau Checks and written references. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 & 38 Quality in this outcome area is excellent. Resident’s benefit from living in a home where their views are listened to and acted upon and promotes their health safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The comments received from relatives /visitors comment cards were extremely positive the following are extracts from the comments received, “We thank the wonderful caring staff who look after my wife so well, also for the treatment of myself & Family for the way they allow us to feel part of my wife’s welfare & care”, “I don’t know how you keep finding these super people. Our total gratitude to all the backup agencies who make this wonderful service possible.
Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 22 Thank you all, “We would like to thank Linda Kench and all the staff for the care and support given to my mother. She has been at Kingsley nearly 18 months and how she has improved with the care and the support of her GP is amazing”, “Just wanted to say how well my wife is being cared for and how nice the staff are to her and us”. “My wife’s condition of life is excellent thanks to all the wonderful staff they even have time to show care and concern for myself & family”, “Kingsley is an excellent Nursing Home, the food is first class the hygiene is to a very high standard and The staff are always friendly and co-operative, an excellent Matron”. The Registered Manager operates an open door policy and was observed to have a good rapport with residents, visitors and staff who all confirmed that the manager has a style of management that was is very open and approachable, residents related well with the registered manager, it was observed that residents with limited verbal communication, initiated contact with the manager smiling in response to her voice. All new employees receive full induction training, followed by ongoing training specific to the needs of the home and mandatory requirements covering Fire, Health and Safety, First Aid, Moving and Handling and food Hygiene training. On each shift the registered nurse on duty provides supervision, support and direction to care staff, in addition there is formal supervision systems in place. and regular staff meetings facilitate information exchange. Quality assurance systems were in place based upon seeking the views of service users and their representatives. The registered provider has regular contact with the home and supports the registered manager in providing a high quality service for the residents living within the home. Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 X X 3 Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kingsley Nursing Home DS0000067790.V313811.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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