Inspection on 27/06/05 for Kingsthorpe View Care Home

This inspection was carried out on 27th June 2005.

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

Kingsthorpe View Care Home 01/08/08

Kingsthorpe View Care Home 12/06/07

Kingsthorpe View Care Home 25/04/06

Kingsthorpe View Care Home 05/10/05

Kingsthorpe View Care Home 27/01/05

Kingsthorpe View Care Home 09/09/04

Kingsthorpe View Care Home 22/03/04

Kingsthorpe View Care Home 10/02/04

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

CARE HOMES FOR OLDER PEOPLE Kingsthorpe View Care Home Kildare Road St Anns Nottingham NG3 3AF Lead Inspector Mary OLoughlin Unannounced 27 and 28 June 2005 at 10.00am 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. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kingsthorpe View Care Home Address Kildare Road St Anns Nottingham NG3 3AF 01384 288924 01384 296733 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) Highfields Care Home No.2 Limited Care Home with Nursing 50 Category(ies) of Dementia (50 years and over) - 50 registration, with number of places Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 13/05/07 Brief Description of the Service: Kingsthorpe View is a purpose built care home of 41 beds in the main unit and a smaller unit of 9 beds. The home is registered to accommodate 50 Older People whose primary need is Dementia. The present arrangements around accommodation is that the main building is used for people requiring Nursing care, with the small 9 bed unit for people requiring personal/ residential type care. The registration category only applies to those people admitted since the change of category, this has resulted in a number of people still receiving care at the home for enduring mental illness as the previous category allowed. The registered Provider has recently merged with another care home provider Southern Cross, the official rebranding of the company name has not been finalised at the time of this report. Situated in the St Annes area of Nottingham, close to the city centre and on a main bus route, the area is mainly residential with a few local shops and community facilities. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken unannounced as part of the monitoring of the service to ensure compliance with the National Minimum Standards. Two inspectors over 5hrs reviewed the care plans of residents, spoke to residents, staff and the acting manager. Due to the nature of the illness that residents experience it is not always possible for the inspector to ascertain their views of the service they receive. The inspector looked at the records of the care planned and provided for along with information and observations at the point of the inspection. Concerns raised by external professionals were considered along with the requirements set at the last inspection and any complaints or adult protection investigations presently being undertaken. The home is being closely monitored by the Commission for Social Care Inspection. There have been improvements to the levels of staff and an appointment of a new manager since the last inspection, although yet to be registered with the Commission. The home was generally clean with some areas of malodour which were being addressed. There were concerns around the management of medicines and care planning for residents, which did not ensure that residents received appropriate care. The inspector left immediate requirements for the provider to ensure that the areas of concern were addressed immediately. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The registered provider has acknowledged the problems in the service and has produced action plans for implementing the required improvements including the provision of training to staff in areas relevant to their practice in the home. However, there is a culture within the staff team of a negligent approach to the nurse’s accountability in their practice. The registered provider must now take steps to ensure that nurses failing to safeguard the wellbeing of their residents are dealt with according to the disciplinary procedure and the Nursing and Midwifery Council code of conduct. Named nurses must take ownership of the management of the conditions of residents ensuring that changes in condition are recorded in a timely fashion and provide any member of staff with a clear record of the care needs of that Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 7 resident. Verbal communication needs to be improved upon between qualified staff and the care team, providing guidance and support to the staff delivering care to the residents. Communication must be improved between qualified nursing staff and external professionals to safeguard the residents and ensure they receive a timely and responsive treatment to changes in their conditions. The manager must ensure that where responsibilities for the management of medicines is delegated to a member of staff, that this arrangement is monitored by the manager to ensure that the provision is adequately managed and the person’s competency is confirmed. Wherever the manager delegates this type of responsibility she must ensure that the staff undertaking these jobs are proficient, this can only be done by supervising the person’s practice over a period of time to ensure their competency. This will prevent situations occurring that put residents at risk, and the reactive style of management that has existed. The Commission for Social Care Inspector may take enforcement action if the provider fails to meet the immediate requirements and safeguard the health and wellbeing of the residents. 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. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 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 Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 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) 1-3 The home’s statement of purpose does not describe the present arrangements around the types of people accommodated at the home, which does not provide people with sufficient information on which to make a decision to enter the home. The arrangements around admission to the home do not ensure that the resident’s needs are met at the time of their admission. The lack of appropriate recording of care needs and strategies to meet the person’s needs may leave residents at risk as staff are not aware of how to meet their needs. EVIDENCE: The previous inspection of March 2005, required the Provider to review the statement of purpose by July 31st 2005, ensuring prospective residents had the information they need to make a decision to enter the home. This is not yet completed. The records of the most recent admission were examined, the file contained a copy of the Primary Care Team Nurse assessment which provided a clear history of the person’s condition and present care needs. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 10 The home’s record of admission was not comprehensively completed and had no signature of the person undertaking the assessment or those involved. The manager confirmed that she had visited the person prior to agreeing admission to ensure that the home were able to met the person’s needs. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-8-9 The management of healthcare and arrangements around the planning of care for the residents does not ensure the safety of the residents accommodated. There is a lack of ownership and accountability from the qualified staff around the continuity of care provided and levels of communication between care staff and external professionals which results in slow responses to the changes in the needs of the residents and access to external professionals. The culture of silence and no action in the event of missing medicines leaves residents without prescribed drugs, which may exacerbate their physical problems and cause deterioration in their condition. Care planning and strategies to manage disorientated and restless residents does not safeguard them from harm. EVIDENCE: Three care plans were examined, one resident recently admitted had only one care plan in place that did not reflect the person’s full needs. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 12 A second care plan had an appropriate nutritional risk assessment in place that had been reviewed monthly. The resident had been losing weight over a six month period, eventually seen by a dietician in June 2005 and prescribed supplements. A member of care staff confirmed that the resident received the supplements as prescribed, however there was no nutritional care plan in place. One resident at risk of wandering from the home had good risk assessments in place and care plans that instructed staff to regularly check that the person was in the building, however the daily information records did not prompt a reevaluation of the plans. Nursing staff had discontinued the nightly monitoring without any evaluation or explanation, the manager was not aware that this action had been taken. The manager confirmed that qualified nurses responsible for care planning had received individual supervision and guidance on care planning. Medicine management gave cause for concern, records of medicine being omitted for one person case tracked could have put the person’s physical wellbeing at risk. Three nursing staff spoken with about the omission of one drug all confirmed to the inspector that although the drug had been received into the home and this was recorded on the medicine record sheet, the medicine had been found to be missing some eight days into a twenty- eight day supply. The qualified nurses had not reported this to the home manager or the residents Doctor. The qualified nurse responsible for the medicine management at the home had been aware and also took no action. Records of a prescribed controlled drug for one resident demonstrated poor practice in the recording of the prescription administration instruction. The medicine administration record had three separate instructions for its administration, staff changing the administration times had not signed or had these changes witnessed. The original change had been undertaken by the Doctor and signed, subsequent changes could not be identified as to whom had written the changes or why. Care staff raised concerns that qualified staff administering medicines do not always stay with the resident to ensure they have taken their prescribed medicines. An immediate requirement was left to ensure the person’s medicines were appropriately managed. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 13 The Commission for Social Care Inspection have been notified by the Primary Care Trust and external professionals, of concerns around the lack of organisation at the home. External professionals contacting the home have had difficulty in gaining information over the telephone as staff are frequently unable to communicate the up to date condition of the residents. The problems are exacerbated by the present system of no central storage of care plan documents, staff answering the telephone have to go to opposite ends of the building to locate records to enable communication in changes. G.P’s encounter difficulties when visiting the home as staff are unable to report the up to date condition of the residents they have been asked to visit. These issues have been raised with the Primary Care Trust and Commission for Social Care Inspection who are investigating these concerns. Care staff spoken with raised concerns around the poor level of communication between care staff and nursing staff. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Mealtimes can be delayed through lack of organisation and the dining tables not laid or presented in a pleasing or attractive manner. EVIDENCE: The breakfast meal was being served at 10.00am during the inspection, tables were not set as the provider’s action plan suggested following the last inspection. The tables were laid appropriately for the lunchtime meal but staff informed the inspector that this was only done for the benefit of the inspectors that day. The manager reported that equipment such as condiment sets had been purchased but many items had gone missing from the home. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16-18 Complaints and adult protection procedures provide a responsive service to any concerns raised. EVIDENCE: The manager has continued to audit accidents within the home and ensure appropriate strategies are adopted to safeguard people from falling. Staff do not always complete records of accidents comprehensively but the manager reviews these documents daily and deals with the issues arising. All complaints and allegations of abuse are taken seriously and the new manager has acted in the best interests of the residents, reporting and investigating concerns raised. The new manager has also written to all local GP’s and the Primary Care Teams to ensure that their concerns are listened to and actions are to be taken to address the problems with communication at the home. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 16 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) 19-26 Improvements in the management of health and safety within the home have been made since the previous inspection and safeguard the residents from harm EVIDENCE: Since the previous inspection the staff at the home have been made aware of the policy for needle stick injury. The arrangements around fire safety have been reviewed and residents are now supervised whilst smoking in the upstairs lounge area. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The number of staff on duty were sufficient to meet the needs of the residents. However, staff deployment to ensure medicines are administered at the required times and residents appropriately supervised is poor and presents a risk to the health and wellbeing of those accommodated. EVIDENCE: The number of staff on duty exceeded the previous staffing levels. Staff spoken with confirmed that there was an improvement in the numbers of staff provided since the last inspection. Staff reported that during morning handover residents were not supervised for up to an hour. Medicine administration time during the inspection was not at the required time and only provided one hour time lapse to the next time drugs would be administered. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 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) 31-32-38 The present manager is not registered with the Commission for Social Care Inspection, which must be applied for within a 28day period. The new manager is providing leadership and the necessary continuity to ensure that practices within the home improve within an appropriate timescale. The methods of moving residents with mobility problems does not reflect safe practice and may pose a serious risk to staff and residents. EVIDENCE: The manager in place has not applied to register with the Commission for Social Care Inspection at the time of this inspection. Staff spoke of a general lack of respect for the management of the home by all grades of staff at the home. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 19 One member of staff spoke of how they felt supported by the new manager. Care staff reported that not all staff use the appropriate methods of moving and handling residents in order to save time. It was suggested by one member of staff that the techniques in use to move immobile residents could be rough and cause unnecessary discomfort. Staff also commented on the lack of sufficient moving and handling equipment at the home. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 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 1 x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 1 3 x x x x x 1 Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 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 1 Regulation 4 Requirement The registered person must ensure that the statement of purpose is completed in the timescale agreed at the last inspection and reflects the appropriate category of registration with information around the present arrangements within the home and the specific areas allocated to meeting the needs of people with enduring mental illness and those with Dementia. The registered person must ensure that a care plan is produced following the preadmission assessment that describes the needs of the resident and how staff are to meet those needs. The registered person must ensure that care plans are 1. Evaluated as conditions change. 2. Nutritional care plans are produced as risk assessment determines. 3. Safeguards in place for those at risk of wandering are not withdrawn unless there is evidence that through C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Timescale for action This requiremen t was set at the inspection of 18/03/05 and the timescale remains as July 31st 2005. August 31st 2005 2. 7 14 3. 8 15 August 31st 2005 Kingsthorpe View Care Home Version 1.40 Page 22 assessment this is required. 4. 9 13 The registered person must ensure that medicines are appropriately managed. 1. Medicines found to be missing must be reported and investigated notifying the Commission of the event and outcome of the investigation. 2. Any ommissions must have a code inserted to provide an audit trail. 3. Ensure hand written prescriptions are signed and witnessed and provide a clear instruction on the times and dosage of medicines. 4. Ensure that the drug trolley is locked to the wall when not in use. 5. Ensure that residents have taken their medicines before leaving them unattended. This requirement is outstanding from the inspection of 13/05/05 The registered person must ensure that appropriate records are held that contain all the up to date information on the condition of residents which will provide the basis for appropriate levels of communication to doctors and external sopecialists. The registered person must ensure that staff left in charge of the home in the absence of the manager are provided with the necessary information to ensure continuity of information and delivery of care. When Doctors visit there must be someone on duty who is able to provide the necessary information on the residents condition and care in place. The registered person must ensure that the care staff and C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Immediate 5. 8&9 14 August 31st 2005 6. 8 14 August 31st 2005 7. 8 12 September 30th 2005 Page 23 Kingsthorpe View Care Home Version 1.40 8. 15 16 9. 27 18 nursing staff communicate and consult on the needs of the residents to ensure that information and changs in condition are appropriately recognised and dealt with. The registered person must ensure that residents are provided with the necessary provision of adapted cutlery and crockery. The registered person must ensure that at peak times of activity staff are deployed appropriately to ensure that meals and medicines are delivered at suitable times, and residents are supervised as required to ensure their safety. This requirement is outstanding from 13/05/05. September 30th 2005 Immediate 10. 11. 38 13 The registered person must ensure that staff undertake the moving and handling procedures as required under health and safety law. Ensure that there is sufficient equipment in place for the moving and handling of residents. Immediate 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. Refer to Standard 8 Good Practice Recommendations The registered person should examine the system of communication within the home and the access to the records required to address external specialists enquiries within a reasonable timescale. 2. Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 24 Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Kingsthorpe View Care Home C53 C03 S39367 Kingsthorpe View V235563 270605 Stage 4.doc Version 1.40 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!