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Inspection on 04/05/07 for Kingsley Nursing Home

Also see our care home review for Kingsley Nursing Home for more information

This inspection was carried out on 4th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Kingsley presented as a warm caring environment. The home had a pleasant atmosphere and residents appeared relaxed, well cared for and comfortable. Visitors were seen popping in at various times and greeted in a friendly manner. Staff were observed to be attentive to the needs of the people living in the home and residents interviewed reported that they were pleased with the overall care and general management of the service. One resident reported, "It is a lovely place to live" and "I could not ask for anywhere better". Resident care files recorded good detail regarding the health and social care needs of the individual and it was evident that the home has good links with outside professionals. Care records evidenced that staff seek advice from the relevant health professional where needed. A resident said, "I can see my GP and the girls will help with the appointments". Through discussion and observation it was evident that residents were treated respectfully and staff interviewed discussed the flexibility of the home`s routine to meet residents` individual needs. Residents interviewed were pleased with the times meals were served and stated that staff did not mind if they got up early or late. A resident reported that staff were very accommodating.Social activities are arranged in house and at Easter time residents and staff made Easter Bonnets. Flower arranging is also popular with the ladies. Some residents prefer to stay in their room and staff respect this wish. One resident reported that she enjoys going out with friends but also with the staff to the village for tea or coffee. Meals are well managed and the menu offered a good range of nutritious foods. Residents interviewed were generally pleased with the standard of cooking and said that the cook regularly asks them what they would like on the menu and if the meals are to their liking. The home is gradually being decorated and a number of bedrooms seen had new fixtures and fittings. The new colour scheme is pleasing and easy on the eye. The home was clean, tidy and there were no unpleasant odours. A resident said, "The cleaning staff do a good job". The home has a complaint procedure and residents interviewed stated that they could speak to the manager at any time and that their concerns would be listened to. A copy of the complaint procedure is displayed in the main hall for residents to view.

What has improved since the last inspection?

Residents are offered a choice of well balanced meals and they are provided with a menu to choose what they would like to eat. Staff are provided with an induction and also have access to mandatory courses in safe working practices. This ensures they have the skills and knowledge to provide care and support to the residents. A copy of the fire safety certificate and electrical certificate were forwarded to the Commission following the last inspection in July 2006. The safety of people using the service is therefore protected in these areas.

What the care home could do better:

There are no requirements from the site visit however good practice recommendations are stated in the main report which will benefit the service. These are made in relation to staff training, providing a new floor in the kitchen, medicine administration and better recording of wound care.

CARE HOMES FOR OLDER PEOPLE Kingsley Nursing Home 4 Trafalgar Road Southport Merseyside PR8 2EA Lead Inspector Mrs Claire Lee Key Unannounced Inspection 4th May 2007 9:00 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 DS0000044817.V332404.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 DS0000044817.V332404.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsley Nursing Home Address 4 Trafalgar Road Southport Merseyside PR8 2EA 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) 01704 566386 Kingsley Nursing Homes Ltd Mrs Barbara Evans Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social care Inspection. 13th July 2006 Date of last inspection Brief Description of the Service: Kingsley is a privately run home providing twenty five places for older people who need nursing care. It is situated in a residential area of Southport with easy access to local shops, the town centre and public transport. The registered provider/owner is Kingsley Nursing Homes Ltd and the manager is Mrs Barbara Evans. The premises are detached and comprise of two buildings over four floors. The home has twenty one single bedrooms (four ensuite) and two 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 the use of a call system with an alarm facility. Recreational space consists of a lounge and conservatory overlooking the front. The conservatory is used as a dining room and quiet area. Both rooms are pleasantly decorated. 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 also some car parking space. A ramp leads to the front door. The weekly fee rate for accommodation ranges from £471.00 to £486.00. The higher rate is charged for a single room with an ensuite facility. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the unannounced inspection, a site visit took place at the home by an inspector over one day for duration of eight and three quarter hours. A partial tour of the premises took place and a number of the home’s care, staff and health and safety records were viewed. Discussion took place with six residents, four staff, the manager and deputy manager. During the inspection three residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. Discussion also took place with three relatives. All the key standards were inspected and also previous requirements and recommendations from the last inspection in July 2006 were discussed. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents prior to the inspection. Comments included in the report are taken from the survey forms and also during the site visit. What the service does well: Kingsley presented as a warm caring environment. The home had a pleasant atmosphere and residents appeared relaxed, well cared for and comfortable. Visitors were seen popping in at various times and greeted in a friendly manner. Staff were observed to be attentive to the needs of the people living in the home and residents interviewed reported that they were pleased with the overall care and general management of the service. One resident reported, “It is a lovely place to live” and “I could not ask for anywhere better”. Resident care files recorded good detail regarding the health and social care needs of the individual and it was evident that the home has good links with outside professionals. Care records evidenced that staff seek advice from the relevant health professional where needed. A resident said, “I can see my GP and the girls will help with the appointments”. Through discussion and observation it was evident that residents were treated respectfully and staff interviewed discussed the flexibility of the home’s routine to meet residents’ individual needs. Residents interviewed were pleased with the times meals were served and stated that staff did not mind if they got up early or late. A resident reported that staff were very accommodating. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 6 Social activities are arranged in house and at Easter time residents and staff made Easter Bonnets. Flower arranging is also popular with the ladies. Some residents prefer to stay in their room and staff respect this wish. One resident reported that she enjoys going out with friends but also with the staff to the village for tea or coffee. Meals are well managed and the menu offered a good range of nutritious foods. Residents interviewed were generally pleased with the standard of cooking and said that the cook regularly asks them what they would like on the menu and if the meals are to their liking. The home is gradually being decorated and a number of bedrooms seen had new fixtures and fittings. The new colour scheme is pleasing and easy on the eye. The home was clean, tidy and there were no unpleasant odours. A resident said, “The cleaning staff do a good job”. The home has a complaint procedure and residents interviewed stated that they could speak to the manager at any time and that their concerns would be listened to. A copy of the complaint procedure is displayed in the main hall for residents to view. What has improved since the last inspection? What they could do better: There are no requirements from the site visit however good practice recommendations are stated in the main report which will benefit the service. These are made in relation to staff training, providing a new floor in the kitchen, medicine administration and better recording of wound care. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kingsley Nursing Home DS0000044817.V332404.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 DS0000044817.V332404.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have an individual care needs assessment prior to admission to ensure the home can meet their needs. EVIDENCE: Three residents were case tracked and an assessment was viewed for a resident who had moved into the home since the last key inspection. The file contained a ‘Daily Living and Needs Assessment’, which had been completed by the manager prior to the admission of the individual resident. The assessment viewed contained key information on the resident’s care and social needs and the information obtained had been used to form the basis for the plan of care. The assesmsent also included a good record of dental, optical, hearing and sight requirements which are so important for an individual. One file contained a care needs assessment from social services as the home were unable to complete their own assessment at the time of admission. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 10 Another file had a transfer letter from a hospital with the relevant information to assist the home with the necessary background details. A ‘Life History’ (which is a brief outline of the person and their background) had also been completed in two files, the emphasis being on family arrangements and preferred hobbies/interests. This gives staff valuable information in helping the resident to settle in to their new surroundings and to arrange interests to suit indivual need. Kingsley does not provide intermediate care and therefore this standard was not assessed. A number of residents have lived at the home for many years. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are addressed in care plans and medicines were being administered according to the home’s administration policy. Care was provided in accordance with the needs, expectations and rights of the people living in the home and residents were observed to be treated with respect. EVIDENCE: As part of the case tracking process three care files were viewed and these contained good information regarding the care needs of the residents. The care files were organised and the easy to read. Consent and agreement to the plan of care had been sought from the resident and/or their next of kin and residents interviewed were pleased with the care provision. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 12 The following comments with regard to the care were made: “Very good care” “The girls do their best” “The staff are good” “The staff are busy but do spend time with me” “The staff listen to me and I can explain what I need” Care plans identified individual care and social needs, for example, mobility, nutrition, personal care, continence management and mental health care. The information had been reviewed monthly to ensure it was accurate and to reflect any change in care provision. Wound care was documented in a plan of care and a wound care chart. A record of whether the affected site is responding to treatment would be beneficial when reviewing the care given. Care staff have a key worker role (extra responsibilities assigned for a number of residents) and they record the care they give with emphasis on social arrangements. The registered nurses also complete a daily record to evidence the care given. Discussion with staff confirmed that they had a good knowledge of the care needs of individual residents and understood the need for promoting independence where possible. A range of supporting documentation was also on file. This included personcentred risk assessments, for example nutritional assessment, care of skin, risk of falls and moving and handling restrictions and instructions for staff. There was evidence of health care appointments and accident records when required. A GP was visiting a resident at the time of the site visit to conduct a medical review. Residents are weighed regularly to monitor weight gain or loss and girth measurements are taken for those residents who are unable to use the scales. Staff complete a monthly health care check for each resident to monitor their health and welfare. Residents interviewed confirmed that they see a chiropodist regularly at the home and that staff arrange optical appointments for them. It was evident that residents receive care according to their individual need and that it is person led. The home had a medication policy and procedure in place, which included procedures for residents who wished to self-administer their medication. Discussion took place regarding a resident who takes complete control of his medications from ordering to delivery. The resident had signed a disclaimer for this practice and the GP and dispensing chemist are aware. A risk assessment should be completed by the home to ensure the resident is safe and competent to administer the medications. The home uses a blister pack system for administering medicines and medication was appropriately stored. Specimen signatures of staff authorised to administer medication were in place. Medication administration records (MAR) viewed had generally been correctly completed and systems were in Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 13 place for the ordering and return of medication. The controlled drug register evidenced two staff signatures for administering medicines liable to misuse in accordance with the home’s administration policy. Care files included a record of whether staff were to administer the medications to the resident. For residents who receive the mediation Digoxin it is good clinical practice to record a pulse rate prior to administering the medicine. A pulse rate had not been recorded each day for one resident. During the day staff were observed offering support and assistance to a number of residents with various aspects of personal care. The help was given in a sensitive and respectful manner. Staff spoken with demonstrated a sound awareness of how to care for the residents and to promote their rights within a care setting. A resident said, “It is not like your own home but the girls really try hard”. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice and control over their lives to meet their expectations, preferred routines and lifestyle. Meals were well managed and residents are offered appealing and nutritious foods. EVIDENCE: Social arrangements in the home are documented in an activities file and care records included details of preferred hobbies and interests. The home offers a good range of social activities and this includes, music, film shows, dog patting, flower arranging, keep fit, beauty days, bingo, mobile library, ‘days gone by’ and dress parties. Outings are arranged and a resident said that she enjoys a trip out to the village with the staff. It was evident that the home strive to provide a stimulating programme based around the needs and preferences of the residents. A resident said they enjoy having their hair done by the hairdresser and Holy Communion is arranged to ensure residents are able to continue to practice their faith. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 15 Visitors were seen to be made welcome and offered refreshments by the staff. A relative said, “I come in regularly and the staff are always very friendly”. Care files viewed contained details of family and friends to ensure contact is maintained. A number of residents were sitting in the lounge and the conservatory. Others had chosen to remain in their rooms. A resident reported that staff respect her wish to remain in her room, as she prefers to be quiet. The routine of the home was discussed with residents with regard to the time meals are served, time of getting up in the morning and retiring at night. The routine appeared to be flexible and staff confirmed that residents can stay in bed in the morning for a rest if they prefer. Another resident said they could have a cup of tea during the night if unable to sleep. Residents are able to bring personal possessions from home and bedrooms seen had been personalised with pictures and personal possessions. This helps the residents to feel more at home with their surroundings. A copy of the menu was provided and residents were being offered a good choice of well balanced hot and cold meals. The home operates a set menu however alternatives are available by request is a resident does not like what is on offer. Food is served in the lounge, conservatory or in residents’ rooms if preferred. The conservatory is used as a dining room. Staff were in attendance to serve lunch and also offered assistance to those who required some help. The help was given in a sensitive manner and not rushed in anyway. Discussion with a resident confirmed that they would like their evening meal served later and this was brought to the manager’s attention. The kitchen although small and domestic in style was clean and well equipped. The home had good supplies of fresh, frozen and dry goods thus providing a varied selection of food. Kitchen staff to ensure the smooth running of the kitchen support the cook. Comments received from residents and relatives regarding the food include: “Good food” “Excellent meals” “Could do with being hotter” “Have never had a bad meal” “Look forward to every meal” “The cook is really good and comes to see me” A recent environmental health report identified that a new kitchen floor was needed due to general wear and tear. The home are looking to replace the existing floor as soon as possible. Environmental health records for food temperatures were up to date to ensure the ongoing safety of the residents. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,17 and 18 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Residents and relatives have confidence that their concerns will be dealt with. They are also able to take part in the electoral process. Abuse policies and procedures are in place to protect the residents. EVIDENCE: The home has a complaints policy in place, which, advises complainants of the process to follow. A copy of the complaint procedure was displayed for residents and relatives to view. No complaints have been received since the last inspection and residents and visitors interviewed had no concerns at this time. They stated that they knew the home would deal with any issues they may have. Feedback from residents via care home survey forms confirmed that residents were aware of how to make a complaint. Only one survey referred to a resident being unsure how to make a complaint and this was brought to the manager’s attention. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 17 A resident confirmed that she had received a postal vote thus enabling her to make part in the electoral process. The home has adult protection and whistle blowing policies in place and also a copy of Sefton and Liverpool’s Adult Protection Procedure. Records showed that some staff have had training in adult protection however this has not been accessed this year. Further training would be beneficial to ensure all staff are familiar with the procedure to be followed. Adult protection is discussed as part of the induction standards for new staff and a staff member interviewed was able to describe what constitutes abuse and how an allegation should be reported. A relative reported, “I have no worries about the care here”. The use of bed rails had been recorded in a care file, as this is a form of restraint. A risk assessment had been completed for its use with consent. The home manages money for a resident; records seen were current and evidenced expenditures. The home was therefore protecting the financial interests of the resident. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,21,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in comfortable, clean, well maintained accommodation. EVIDENCE: Kingsley consists of two houses that have been joined together. Accommodation is available on all three floors, the laundry room, staff room and storage space situated in the basement. The ongoing maintenance and decoration plan for the building contributes to a pleasant homely environment. The home has a large attractive entrance hall and overall, areas viewed appeared to be in good order and well maintained. Bedrooms are gradually being decorated and plans are in place to put in a walk in shower in one of the bathrooms. Although the bathrooms are small and domestic in style they are fitted with bath chairs to assist those less able. Toilets are also fitted with raised seat to assist the residents. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 19 External grounds are kept in good order. The home has a small car park to the front of the premises and work is currently being carried out to the external fire escape due to general wear and tear. Water temperature checks to the baths were completed to ensure the hot water is delivered at a safe temperature. Residents confirmed that hot water is plentiful. Emergency lighting is provided in the building and subject to a monthly in house check and annual service contract. Records seen were current to ensure the ongoing protection of the residents. The home has a policy for the control of cross infection and staff confirmed that they have access to gloves and aprons. Control of Substances Hazardous to Health (COSHH) data is available in the office however up to date information should also be available in the laundry room on products in use. This was brought to the manager’s attention. The home was clean and tidy and residents stated that this good standard of cleanliness was always maintained. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs sufficient numbers of trained staff to care for the residents. Recruitment practices are robust to protect the residents EVIDENCE: Direct observation, discussion with staff and inspection of rotas confirmed that sufficient numbers of staff are employed to provide care and support to the residents. Staffing numbers are based around outcomes for people and staff confirmed that the manager does not allow staffing numbers to drop. A registered nurse is on duty twenty fours a day and during the day there are four care staff in attendance. At night there are two care staff. The home employs two cooks, kitchen staff, domestic staff, laundry assistant and a maintenance man. The manager is supernumerary however does work closely with all staff to monitor care practices. During the site visit the manager was on duty with the deputy matron/manager. Residents spoken with were generally pleased with the number of staff on duty and were aware that agency staff are not used. Existing staff cover any outstanding shifts to provide continuity of care. One care home survey form referred to the home needing extra staff and this was brought to the manager’s attention for further discussion with the resident/relative. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 21 Discussions with residents and visitors confirmed that sufficient numbers of domestic staff are on duty and the home was kept clean and odour free. The home currently has no job vacancies and employs fifteen care staff. The manager is however looking to recruit extra care staff to boost the numbers as some staff work extra shifts. Comments regarding staff include: “Good staff” (relative) “Very kind” “The staff work hard” “The staff are very nice” “Lovely people” “Staff answer the buzzers as soon as they can” “Sometimes you have to wait for the staff but they are busy and will get to you when they can” NVQ (National Vocational Qualification) training for staff is ongoing and the pre inspection questionnaire confirmed that 51 staff have achieved a qualification in NVQ. A staff member interviewed confirmed that she is undertaking NVQ training and also that she was pleased with the level of support provided by the manager with her studies. Staff files should contain certificates for NVQ and the manager confirmed that these would be put in the respective files. Recruitment practices are robust to protect the residents. Three staff files were viewed and these contained a completed job application form with details of past employment, a health declaration, two references, CRB disclosures and/or POVA checks. The manager should ensure all references are dated when completed by the referee, as references must be received prior to employment. This will help evidence this information. Staff are given a contract, job description and handbook when they commence employment. New staff receive an induction and the manager is in the process of completing induction standards with two new staff. This will ensure they have the skills and knowledge to undertake the work. The induction is in line with Skills for Care and is being given over a period of time. An initial induction checklist is also completed when they commence work. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 22 The home’s training matrix was seen and also copies of certificates for courses attended are kept in staff files. Staff have received training in moving and handling, food hygiene and fire prevention. Infection control training and first aid is now being arranged and it was agreed that a list of these dates would be forwarded to the Commission. The home currently employs thirteen staff with a certificate in first aid. Other courses accessed include care of the dying, diabetes and continence management. Dementia care training is planned later this year. PIN (personal identification numbers) for registration with the NMC (Nursing Midwifery Council) for registered nurses was seen. Two dates had expired however it was confirmed that the nurses had renewed their PIN and the list was being updated at this time. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from a home that is well run. Quality assurance processes ensure residents’ views are taken into account. Residents’ finances and their health and safety are protected by the home’s policies and procedures. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager is Mrs Barbara Evans and Mrs Evans attends mandatory training in safe working practices with the staff. Mrs Evans has not completed NVQ Level 4 in management but has many years experience in the care setting and working with older people. Mrs Evans is also a registered nurse. Discussion with staff confirmed that Mrs Evans was “Fair”, “Kind”, “Very supportive”, “A good manager” and “Good boss”. A staff member said, “I would not work anywhere else”. The manager is supported by a deputy manager, a full compliment of registered nurses and the owner who visits the home regularly. The deputy manager is undertaking NVQ Level 4 in Management. A resident commented on how well the manager and deputy manager work together to make a happy home. Staff meetings are not held regularly however one is planned later this month. The manager confirmed that she would look to hold meetings on a more regular basis in the future. Staff interviewed stated that although meetings are infrequent they receive supervision on a one to one basis to discuss training requirements and any concerns they may have. They also have a hand over at each shift change to discus the care needs of the residents. Staff records seen evidenced dates of recent supervision sessions. The home has commissioned an external quality assurance assessment and this involves asking residents and/or relatives to complete satisfaction survey forms. Survey forms seen reported positively regarding the service. Residents also receive a food survey and the comments are fed back to the cook and changes made to the menu as needed. The home are looking to introduce a resident and relative meeting as part of the quality assurance process. The owner of the home undertakes a formal visit to the home each month to speak with residents and staff, view the premises and inspect number of the home’s records. A report is completed in line with Regulation 26 of the Care Standards Act. Reports seen give a good record of the service and they are also made available for staff to read. Financial records for a resident were viewed. These were kept in good order to protect the financial interests of the residents. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 25 The home’s fire logbook showed that weekly tests of the fire alarm take place and staff received fire prevention training in March 2006. A fire drill was conducted in April 2007 so that staff are aware of the action to take in the event the fire alarm sounds. A fire risk assessment of the premises was seen and this has been updated in accordance with the changes in fire legislation. A number of contracts were viewed and these included satisfactory records for servicing the gas and electric supply, passenger lift and moving and handling equipment including bath hoists. This helps protect the people who use the service. The home has a good range of policies and procedures, which are available for staff. There has been no formal equality and diversity training in the home however this subject is covered in the induction standards for new staff and the manager promotes equal opportunities for all staff. It was evident during the site visit that staff provide holistic care to the residents, their individual needs are taken into account and staff provide a service, which provides an increase in quality of life. The manager leads a team of staff who provide person centred care within a warm caring environment. Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 x 3 x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. 1. 2. Refer to Standard OP8 OP9 Good Practice Recommendations Wound care records should include details of whether the affected site is improving as part of the ongoing management and treatment. Staff should complete a risk assessment for those residents who wish to administer their own medications to ensure they are capable and safe to undertake this practice. A pulse rate should be recorded for residents who receive the medicine Digoxin, this demonstrates good clinical practice. The floor in the kitchen should be replaced in accordance with guidance from environmental health. The floor needs replacing due to general wear and tear. Adult protection training should be provided to ensure staff are aware of the procedure to be followed in the event of an allegation. Certificates for NVQ courses should be kept in staff files to evidence completed training. 3. 4. 5. OP15 OP18 OP28 Kingsley Nursing Home DS0000044817.V332404.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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