Inspection on 07/07/05 for Kingsmead Care Home

This inspection was carried out on 7th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 17/01/06

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 7th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kingsmead Care Home Address 63 Prospect Place Old Town Swindon Wiltshire SN1 3LJ 01793 422333 01793 422666 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Gillian Whiter Care Home 43 18 18 18 18 25 1 Category(ies) of DE Dementia 45 years and over registration, with number DE(E) Dementia - over 65 of places MD Mental Disorder - 45 years and over MD(E) Mental Disorder - over 65 OP Old Age PD Physical Disability Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users who may be accommodated in the home at any one time is 43. 2 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. 3 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. 4 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. 5 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. 6 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. 7 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. Date of last inspection 6th January 2005 Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 5 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 D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.45am and 5.15pm. There were 39 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. There were a high number of frail residents in the home, many of who were unable to communicate with the inspector. Service users are known as residents in this home and will be referred to as such throughout this report. 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: Some residents care plans and records were not always completed and residents need to be weighed regularly if they have problems with their nutrition. Call bells should be answered promptly at night. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 7 Although there was evidence of staff receiving some relevant training, there is a need to ensure that they all attend mandatory training at the required intervals, including fire safety and abuse awareness. Improvement was required in the cleanliness of the laundry and the disposal of wound dressings. Bathrooms could be enhanced for the residents by removing items such as duvets and incontinent pads that are stored in them, and by removing information posters for staff. Staff must ensure that fire doors are not propped open at any time. The fitting of automatic closure devices those fire doors without them would reduce this risk. 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 D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. Standard 6 does not apply to this home. Residents’ needs are assessed prior to admission and the home has the capacity to meet those needs. EVIDENCE: Care plans provided evidence that the manager undertook pre admission assessments. Other supporting pre admission documentation was available, such as social services assessments. Kingsmead is registered to provide nursing care for elderly people, nursing care for people aged 45 or over with mental health problems, and ‘residential care’ support for up to seven elderly people. The environment is suitable and the adaptations and equipment appropriate. Staff training appears to be appropriate to the needs of the residents. The positive comments of the residents and relatives spoken to during the inspection, allied to inspectors observations would indicate that the home has the capacity to meet the assessed needs of the client groups. Where the home is not able to meet a person’s needs, then appropriate action is taken to find a more suitable placement for them. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 The standard of care planning is variable and does not always reflect needs. Residents’ health care needs appear to be met, but recording practice needs to improve. EVIDENCE: Care plans, in the main, reflected assessed needs however a resident who had undergone surgery and another with a heart condition, did not have care plans to direct care. Another, who was assessed as at risk from development of pressure sores, had the appropriate equipment in place but no care plan to direct and monitor progress. There was evidence of monthly reviews and social assessments had been undertaken. Residents who could voice an opinion were happy with the care and support given, stating ‘they help me a lot’ and ‘staff are kind’. One reported some delay in answering call bells at night. Two sets of relatives were happy with care. Visits to frail residents confirmed that equipment was in place to meet assessed needs. There were some gaps in records used for monitoring turns and fluids, and two residents assessed as nutritionally at risk were not being weighed. There was a lack of consistency regarding the recording of wound Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 11 care and a previous good practice recommendation regarding the use of wound assessment documentation had not been implemented. Care plans confirmed support from health care professionals, such as the tissue viability nurse, therapists and hospital consultants. Evidence of good practice included the monitoring of a resident’s sleep patterns, the progress made by a resident admitted for short-term rehabilitation and prompt referrals to GP’s. Those residents on the mental health unit were not unduly agitated and staff were calm and supportive. Although standard 10 was not fully assessed during this inspection, a dry wipe board on the nursing corridor wall was noticed, which indicated when residents were having baths. This may be seen as an intrusion of privacy and this was discussed with the manager at the end of the inspection. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. The social and nutritional needs of the residents are met and they maintain their own lifestyle as far as possible, with the support of the staff if necessary. Residents are able to maintain contact with family, friends and the local community. EVIDENCE: Two activity staff were employed and there was evidence that a variety of in house and external activities were provided for residents on all the homes units, and information was available. Residents said that they had a choice as to whether they joined in activities or not. Religious beliefs were recognised. There are no restrictions on visiting unless at the residents request. Visitors were in the home during the inspection and residents confirmed that they had contact with friends and relatives. Visitors could be received in residents’ rooms. Links with the local community were mainly via external activities. There were mainly positive comments regarding the meals served in the home. The meal on the day offered a choice of main course and a sweet course. Special diets were catered for. One negative comment was that the sweet course sometimes lacked accompanying sauces. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Any complaints are listened to and action is taken to resolve them. Recruitment procedures protect service users from possible abuse, however staff awareness of abuse issues needs to be improved. EVIDENCE: A review of the complaints book indicated that there had been three complaints since the last inspection held on the 6th January 2005. All complaints had been dealt with appropriately and in a timely manner. Two of the complaints were not upheld and a third, regarding a communication issue was partially upheld. Residents and relatives were aware of whom to complain to if necessary. Staff files reviewed indicated that CRB checks had been obtained and that POVA checks and references were obtained prior to new staff members commencing employment. Conversation with staff indicated that awareness regarding the local procedure for reporting suspected abuse needed to be raised. Not all staff had received mandatory training in abuse awareness. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,26 The environment is well maintained and safe and there are accessible communal areas. There are sufficient toilet and bathing facilities but these could be enhanced further. The home is generally clean, however some hygiene practices require improvement. 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. The home appeared to be well maintained and records confirmed this. There was an ongoing programme of redecoration and carpet replacement however the carpet in room 41 required replacing. Furniture was of a satisfactory standard. New corridor carpets are to be fitted in January 06. The majority of service users bedrooms have en suite facilities. One bathroom on the residential unit was unused and a recommendation was made at the last inspection that this bathroom could be better utilised as a shower room. A downstairs bathroom was being used to store quilts and blankets, continence pads were stored by the toilet and a wound dressing had been disposed of in an ordinary black bag. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 15 Following a requirement of the previous inspection, the manager reported that six adjustable nursing beds had been purchased and more were on order. The standard of cleanliness was generally satisfactory but varied between units and this was discussed with the manager. An unpleasant odour was noted on the ground floor nursing unit, but this had improved by the end of the inspection. The laundry was mainly clean apart from an accumulation of dust behind laundry machines. There is a need to ensure that net pants are for individual use only. The kitchen was clean and food hygiene measures were in place. Fly-screens had been purchased and were to be fitted to the kitchen windows. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 There are enough trained and competent staff to meet needs but the number of those attending mandatory training needs to improve. The recruitment practice protects the residents. EVIDENCE: There were two registered nurses and seven care assistants on duty on the day of the inspection. Care staff indicated that they felt staffing levels were generally high enough and did not appear unduly stressed by their workload. Inspection of 3 weeks duty rota indicated levels were satisfactory and that there were normally two nurses and three care assistants on waking duty overnight. Residents indicated that levels were high enough. The number of domestic and support staff appears appropriate. The manager reported that of thirty care staff, two had achieved NVQ3 and nine NVQ2. This equates to approximately 37 of care staff with an NVQ. Two further staff had almost completed NVQ2 and two were about to start. Four Seasons Health Care now have a NVQ training department. There is one adaptation nurse working as a care assistant. There is a commitment to reach the minimum level of 50 care staff with NVQ2 or equivalent. Records indicated recruitment practice was satisfactory, appropriate checks had been carried out and documents were available Records indicated that not all staff had received mandatory training. Records of induction training were available along with further training in relevant Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 17 subjects, such as dementia care, safe handling of medicines and care planning. Staff confirmed that training had been undertaken and a manual handling training session was being held on the day of the inspection. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31and 38 The manager is well qualified and experienced to run the home. The health, safety and welfare of residents’ and staff is compromised by some current practices EVIDENCE: Mrs Whiter is a registered nurse and was appointed as manager in April 2003. Ms Whiter 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 almost 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 15 requirements arising from this inspection, three of which are unmet from previous inspections. The manager and provider require diligence in ensuring adherence to the regulations and completion of statutory requirements. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 19 The fire log indicated that fire safety tests were undertaken at the required intervals however there had been minimal mandatory staff fire safety training. Two fire doors were propped open in the annexe, the risk to the safety residents was discussed with the manager and the providers should seriously consider fitting automatic closures to fire doors in this part of the building. Staff were observed taking precautions regarding the prevention of cross infection. The maintenance record indicated that gas, water and electrical safety tests had been carried out. Lifting equipment had been serviced. Routine checks of hot water temperatures and the call bell system were also recorded. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 2 x x x x 2 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x x x 2 Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2,b) Requirement The registered manager is required to ensure that care plans are updated following any change in care needs. (Unmet requirement from inspection held 6/1/05) The registered manager is required to ensure that all service users who have been assessed as being at risk for the development of 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. The registered manager is required to ensure that night staff respond to call bells promptly. The registered manager is required to ensure that those residents assessed as being nutritionally at risk are, if physically possible, regularly weighed. The registered manager is Timescale for action 7/7/05 2. OP7 15(1) 7/7/05 3. OP8 12(1,a,b) 7/7/05 4. OP8 12(1,a) 7/7/05 5. OP8 12(1,a) 7/7/05 6. OP10 12(4,a) 7/7/05 Page 22 Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 7. OP18 13(6) 8. OP18 13(6) 9. 10. OP19 OP21/26 16(2,c) 13(3) 16(2,j) 13 (3,4) 11. OP26 12. OP26 13(3) 13. 14. OP26 OP30 13(3) 18(1,a,c) 15. OP38 23(4,a) required to ensure that personal information regarding residents care needs is not displayed in communal areas. The registered manager is required to ensure that all staff receive abuse awareness training. The registered manager is required to ensure that staff are made aware of the local guidelines for the reporting of suspected abuse. The registered provider is required to ensure that the carpet in room 41 is replaced. The registered manager is required to ensure that bathrooms are not used for storage purposes. The registered manager is required to ensure that wound dressings are disposed of in appropriate recepticles. The registered manager is required to ensure that the area behind the laundry equipment is cleaned. The registered manager is required to ensure that net pants are for individual use only. The registered manager is required to ensure that all staff attend mandatory training at the required intervals. The registered manager is required to ensure that fire doors are not propped open by any means other than an automatic closure device approved by the fire service. (Unmet requirement from inspection held 6/1/05) 1/10/05 1/8/05 1/9/05 7/7/05 7/7/05 7/7/05 7/7/05 7/7/05 7/7/05 16. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 23 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 OP21 Good Practice Recommendations It is recommended that in order to evidence good practice, a recognised wound assessment tool be used. It is recommended that in order to enhance current facilities, thought be given to converting the unused bathroom on the residential unit into a shower room. Kingsmead Care Home D51 D01 s15923 KingsmeadCareHome v234613 070705 Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire 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. 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