Inspection on 17/01/06 for Kingsmead Care Home

This inspection was carried out on 17th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kingsmead Care Home 04/11/08

Kingsmead Care Home 16/11/06

Kingsmead Care Home 07/07/05

Kingsmead Care Home 06/01/05

Kingsmead Care Home 19/07/04

Kingsmead Care Home 27/01/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kingsmead Care Home 63 Prospect Place Old Town Swindon Wiltshire SN1 3LJ Lead Inspector Steve Cousins Unannounced Inspection 17th January 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 Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 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. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kingsmead Care Home Address 63 Prospect Place Old Town Swindon Wiltshire SN1 3LJ 01793 422333 01793 422666 kingsmead@fshc.co.uk 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) Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Gillian Whiter Care Home 43 Category(ies) of Dementia (18), Dementia - over 65 years of age registration, with number (18), Learning disability (1), Mental disorder, of places excluding learning disability or dementia (18), Mental Disorder, excluding learning disability or dementia - over 65 years of age (18), Old age, not falling within any other category (25), Physical disability (1) Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No more than 18 service users in the category old age, not falling within any other category, may be in receipt of nursing care and must be accommodated on the ground floor No more than 18 persons aged 45 years and over with a mental disorder or dementia may be accommodated at any one time. These service users must be accommodated on the first floor. The `Annex` area may not be used for service users in receipt of nursing care whether in the OP, MD, MD(E), DE or DE(E) categories The staffing levels set out in the Staffing Notice issued by Wiltshire Health Authority on 26 September 2000 in regard to Kingsmead Nursing Home (Registration number QD7 - 8E577) must be met at all times in respect of the service users accommodated on the ground floor The staffing levels set out in the Staffing Notice issued by Wiltshire Health Authority under Sections 22(1) & 23(4) of the Registered Homes Act on 28 May 1999 in regard to Kingsmead Nursing Home (registration number QD7 - 8F177) must be met at all times in respect of the service users accommodated on the first floor The only service user who may be accommodated in the category PD is the male service user named in the application dated 11 April 2005. The only service user who may be accommodated in the category LD is the male service user in the application dated 28 June 2005. 7th July 2005 5. 6. 7. Date of last inspection Brief Description of the Service: Kingsmead Nursing Home is situated in Old Town, Swindon and is close to local shops and bus routes. The home is a modern building on two floors and has accommodation for up to forty-three older people. It is split into three sections, comprising of a seven-bedded residential unit, an eighteen bedded nursing unit and an eighteen-bedded dementia/mental health unit. The home is part of the Four Seasons Healthcare group and the registered manager is Gill Whiter. There is a minimum of two qualified nurses on duty at all times, supported by care assistants. Kitchen, domestic, administration and maintenance staff are also employed. Most of the bedrooms are single en-suite rooms. There is a safe, enclosed and accessible rear garden that contains a seating area. There are parking areas to the front and rear of the home. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Service users are known as residents in this home and will be referred to as such throughout this report This unannounced inspection took place between 9.30 am and 6.00 pm. There were 40 residents in the home. The findings from this inspection are based on a tour of the premises, speaking to residents, relatives and staff, and visiting frail residents. A number of records were inspected, including care plans and staff files. The findings were discussed with Mrs Whiter, the registered manager, at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: As found during the previous inspection in July 2005, care plans need to be improved, as does the recording of fluid input and wound care. There is also a need to ensure that residents have support in all aspects of their personal care, such as hair, nails and clothing; and that they have access to their call bells. Improving quality monitoring systems may help address these issues. Although generally clean, a bathroom and a bedroom required further attention and a lounge carpet needed to be replaced. Some hygiene practices need to improve. More adjustable beds are also required. Although accidents are recorded and regularly audited, more action is required to prevent accidents reoccurring Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 6 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. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Residents or their advocates are issued with contracts detailing terms and conditions of occupancy. Residents are assessed prior to moving in to ensure the home can meet their needs. EVIDENCE: Four Seasons Health Care issues terms and conditions of residence for residents who purchase their care privately and for those who are funded by local authorities. These include details of fee arrangements. Care plans provided evidence that the manager undertook pre admission assessments. Other supporting pre admission documentation, such as social services assessments and hospital discharge summaries had been used support assessments. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 9 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 and 8 Residents have care plans in place, but these do not always accurately reflect their needs. Residents’ health care needs are met but there could be some improvement to the personal care delivered. EVIDENCE: A selection of care plans was reviewed. Plans were not always in place to direct care where a risk had been identified, such as pressure damage or nutrition/hydration. One resident with a swallowing problem did not have a care plan with regard to their nutrition or safety. Records of wound care were available however an appropriate assessment tool was not being used for one resident. Plans in use were based on ‘core care plans’ and did not appear to be personalised in order to provide a person centred approach to care. Frail residents were receiving appropriate interventions as directed by assessment and those nutritionally at risk were regularly weighed. Appropriate pressure relief equipment was in use where indicated by assessment. It was observed that there was lack of attention to some areas of some residents’ personal care, such as nails, hair, facial hair, oral care and clothing. One frail resident had a dry mouth and sticky eyes. Residents stated the staff respond to call bells promptly, however one resident was unable to reach their call bell Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 10 whilst in bed, putting them self in danger of falling trying to reach it. Some fluid recording charts appeared incomplete making it difficult to assess if the person was receiving enough to drink. Care records indicated that staff referred residents to appropriate health care professionals when required, although in one case not all referrals and outcomes had been detailed. Residents’ spoken with confirmed that they were able to access their GP and other relevant health care professionals. They were also happy with the care and support provided by the staff. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 11 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 and 13. There is a commitment to meet the residents’ social, recreational and religious needs and residents are able to maintain contact with family, friends and the community. EVIDENCE: An activity person is employed and a range of in house and external social events are organised and information about these events was displayed. Church services are also arranged. A hairdresser was visiting the home during the inspection. Three residents spoken with in the downstairs lounge indicated they were happy with life in the home. It was reported that there are no restrictions on visiting unless at the residents request. Visitors were in the home during the inspection and some residents confirmed that they had contact with friends and relatives. A family newsletter is produced every six months. Visitors could be received in residents’ rooms or in the communal areas. Links with the local community were mainly via external activities. Although standard 15 was not fully reviewed, there were positive comments from residents about the meals available such as ‘the food is good’ and ‘we get plenty to eat’. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 12 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 and 18 Complaints are listened to and action is taken to resolve them. As far as possible, residents are protected from abuse however procedures regarding staff references need to be more robust. EVIDENCE: The complaints record indicated that no complaints had been received since the previous inspection. Those previously received had been dealt with appropriately and in a timely manner. The complaints procedure is on display in the home and is contained in the service users guide. It needed to be amended to state that complaints can be sent to CSCI at any time. A comments book is also available in the reception area. Recruitment records indicated that CRB and POVA checks are obtained for all new staff. In one case, a reference had not been obtained from a previous healthcare employer and the need for this was discussed with Mrs. Whiter. Protection of vulnerable adults training is mandatory and local guidelines for reporting suspected abuse, along with a ‘whistle blowing’ policy, are available. Procedures for the handling of residents’ monies are in place. The current system of paying all monies received for residents’ personal use into one non interest gaining bank account does not meet current regulations, however the Commission recognises that the procedure is in place for the benefit of the residents and is well regulated and monitored to ensure probity via a weekly audit by the manager and administrator, and a monthly audit by a Four Seasons representative. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 13 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): 20,24 and 26 There are safe and comfortable communal facilities. The home is generally clean, however improvement is required in some areas. Residents’ rooms suit their needs, although more adjustable beds are required. EVIDENCE: Accommodation is provided on two floors with secure access via stairwells and two lifts. The home has adequate dining and communal areas and a secure, accessible garden area. Furniture was of a satisfactory standard and the home well decorated. Automatic closures to fire doors have now been fitted to bedrooms in the annexe area to improve fire safety in this part of the building. Carpets were generally in good condition, however the one in the upstairs sitting room was heavily stained. The manager stated that this was due to be replaced. The carpet in room 41 had been replaced since the previous inspection. The majority of the residents’ bedrooms have en suite facilities. They were mainly well decorated and some were personalised. Some residents with nursing needs had inappropriate, non- adjustable or movable, divan beds, Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 14 which present a possible health and safety risk to both residents and staff. Following the inspection, Mrs Whiter confirmed that two adjustable beds had been ordered and that agreement had reached with the providers, Four Seasons Health Care, to provide more. There is a statutory requirement relating to this. The home was found to be generally clean and free from unpleasant odours apart from in vacant room and this was brought to the manager’s attention. A bathroom on the nursing unit required cleaning around the bath hoist, bath chair and floor. The pedal bin did not have a top causing an odour and a potential infection control risk. This bathroom was no longer being used for storage of bed linen and continence supplies. The laundry was clean and the equipment in working order. A system for the handling of soiled linen was in place, however there was no soap or disposable hand towels for hand washing presenting an infection control risk. There is still a need to ensure that net pants are for individual use only to promote residents dignity. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 15 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 and 30. The numbers and skill mix of staff met the residents’ needs and staff are trained and competent. The residents are protected by the homes recruitment practice. EVIDENCE: On the day of the inspection there were four care assistants and one nurse on the nursing and residential unit and three care assistants and a nurse on the dementia unit. There appeared to be enough staff on duty to meet the needs of the residents, however at one stage all the staff on the dementia unit were in the office and the residents were unsupervised. This was discussed with the nurse on duty and the manager. Staff spoken to confirmed that training had been provided. One felt that training in looking after people with challenging behaviour would be useful. Thirteen of the homes thirty-two care assistants have an NVQ with a further five currently obtaining one. Not all records of mandatory training were available during the inspection, however these have since been provided by the manager and indicate that mandatory training has been provided. A training plan for the year 2006 is in place. It is recommended that an additional fire training person be appointed to ensure that this is provided on induction and regularly throughout the year. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 16 A selection of staff recruitment documents were reviewed and found to be satisfactory, apart from the lack of a reference from a previous employer as referred to in the Complaints and Protection section of this report. Records of induction training were seen and two staff confirmed that they had received induction training. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 17 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 and 33. The manager is well qualified and experienced to run the home however current quality assurance and monitoring systems could be enhanced to ensure that the standard of the service is consistent and requirements and regulations are being met. EVIDENCE: Mrs Whiter is a registered nurse and was appointed as manager in April 2003. She was previously employed as the homes deputy manager and has worked at Kingsmead since 1998. She is currently undertaking a degree in Gerontology and has completed the Registered Managers Award. Mrs Whiter is supported in her role by a deputy, and is line managed by a regional manager. There are fourteen requirements arising from this inspection, three of which are unmet from previous inspections. As stated in the previous inspection report, the manager and provider require diligence in ensuring adherence to the regulations and completion of statutory requirements. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 18 An annual satisfaction survey is carried out which involves canvassing the views of residents, relatives and GP’s and the manager has plans to introduce regular care audits which would enhance current quality monitoring. Standard 38 was not fully assessed during this inspection however, accidents were recorded and audited but there was little evidence of action taken to reduce risk to individuals who frequently fell and this was discussed with Mrs Whiter. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 19 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X X Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (2,b) Requirement The registered manager is required to ensure that care plans fully reflect residents assessed needs. The registered manager is required to ensure that all service users assessed as being at risk of developing pressure damage have a plan in place to direct care. Unmet requirement from inspection held 6/1/05 The registered manager is required to ensure that, in order to evidence practice, intervention charts are fully completed. Unmet requirement from inspection held 7/7/05 The registered manager is required to ensure that, in order to evidence good practice, a recognised wound assessment tool be used. Recommendation from inspection held 7/7/05 The registered manager is required to ensure that residents personal care needs are fully DS0000015923.V275074.R01.S.doc Timescale for action 17/02/06 2 OP7 15 (1) 17/02/06 3 OP8 12(1,a,b) 17/01/06 4 OP8 12(1,a,b) 17/01/06 5 OP8 12(1,a,b) 17/01/06 Kingsmead Care Home Version 5.1 Page 21 6 OP8 7 OP16 8 OP18 9 OP20OP26 10 OP24 11 OP26 12 OP26 13 OP26 14 OP38 met The registered manager is required to ensure that service users have access to call bells at all times 22 (7,b) The registered manager is required to ensure that the complaints procedure in the service users guide is amended to state that complaints can be referred to CSCI at any time. 19(1a,b,c) The registered manager is Sch2(3,4) required to ensure that where a person has previously worked in a position involving contact with vulnerable adults, then a reference is obtained along with written verification of why they ceased to work in that position, unless it is not reasonably practical to do so. 13 (3) The registered provider is required to ensure that the carpet in the first floor sitting room be replaced. 16 (1,2,c) The registered provider is required to ensure that, unless at the request of the resident, adjustable beds are provided for those requiring nursing care 13 (3) The registered manager is required to ensure that the bathroom identified during the inspection, and the equipment in it, be thoroughly cleaned. 13 (3) The registered manager is required to ensure that net pants are for individual use only. Unmet requirement from inspection held 7/7/05 13 (3) The registered manager is required to ensure that hand washing facilities are available in the laundry at all times. 13 (4) The registered manager is required to ensure that, where possible, appropriate action is taken to reduce the risk of 12 (1,a,b) DS0000015923.V275074.R01.S.doc 17/01/06 17/02/06 17/02/06 17/04/06 17/06/06 25/01/06 17/01/06 17/01/06 17/01/06 Kingsmead Care Home Version 5.1 Page 22 accidents to service users. 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 Refer to Standard OP21 OP30 OP38 Good Practice Recommendations It is recommended that in order to enhance current facilities, the unused bathroom in the annexe be converted into a shower room. It is recommended that staff receive training in the management of challenging behaviour. It is recommended that an additional fire training person be appointed. Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Kingsmead Care Home DS0000015923.V275074.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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