CARE HOMES FOR OLDER PEOPLE
Kingsthorpe View Care Home Kildare Road St Anns Nottingham NG3 3AF Lead Inspector
Stephen Benson Unannounced Inspection 5th October 2005 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 Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 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. Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kingsthorpe View Care Home Address Kildare Road St Anns Nottingham NG3 3AF 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) 01384 288 924 01384 296733 Southern Cross Care Homes No 2 Limited Vacant Care Home 50 Category(ies) of Dementia (50) registration, with number of places Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27/06/05 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 DS0000039367.V255303.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second of two unannounced inspections carried out between April 2005 and March 2006. The inspection lasted for 6 hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with the manager, care staff on duty and care practices were observed. The premises were not inspected in detail but various areas of the home were visited as part of the inspection What the service does well: What has improved since the last inspection? What they could do better:
There were some errors seen in care plans inspected and a risk identified through an assessment was thought to be inaccurate by the manager. Residents are not being involved in preparing or reviewing their care plans. One resident had a dressing on a wound that should have been changed which had not been noticed by staff when getting him up. Practices for shaving residents were poor, th4ey included at times sharing razors and toiletries. Only disposable razors are used which may not be of a type suitable to all residents. A member of staff had been pricked by a needle left in a residents’ bedroom. The cause of this has not been established. During the morning drugs round the trolley was seen left open an d unattended on one occasion. Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 6 A new cook has started in the kitchen who was planning meals day by day and did not have a menu to follow. One resident has expressed a liking for Indian food but there was no record made to show that this has been provided. There was a badly torn chair in then lounge and an ensuite toilet has been removed due to damage. There were differing reports made as to the frequency which the home has been run below the required staffing level but on the occasions when this has happened no record is made of this. A number of instances of low staff morale were seen during the inspection. Access to the home is up a secluded road where the street lighting is often not working, but no risk assessment for their safety has been carried out. On the first floor corridor there is a gap in the handrail provision resulting in residents using a radiator in its place. Cleaning materials were not being correctly dispensed along with the product guidelines. 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 DS0000039367.V255303.R01.S.doc Version 5.0 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 Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 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): None EVIDENCE: Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 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, 8 and 9 Care plans cannot be relied upon to accurately reflect the needs of residents. More attention is needed to meet the personal and health needs of residents. Unsafe practices are occurring whilst attending to the health needs of residents. EVIDENCE: Care plans include assessments, risk assessments and plans of care. One assessment seen said that the resident was at a high risk of falls but did not have a care plan. The manager felt that the assessment was inaccurate. Their were some plans seen that showed recent incidents being responded to and care planned but not all plans had not been regularly updated and they did not show involvement of residents in preparing or reviewing their plans. Residents said they had not seen their plans. The current care plans are due to be switched to the ones used by the new provider. Staff said they would like more training on completing care plans. Staff said they report any concerns regarding residents’ health to the duty nurse. One resident was seen with a dressing that required changing and this had not been monitored or identified when getting him up and dressed. The arrangements for shaving residents gave cause for concern. This included on occasions shaving residents with the same disposable razor due to insufficient
Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 10 stocks available. Staff said there have been occasions when they have cut residents when shaving them as a result of the type of razor used, which had not been recorded in the accident book. There were not any psychological assessments in care plans but the manager showed some new documentation she is to introduce shortly. Records showed that residents have access to health services and residents confirmed this to be the case. There has been a recent incident where a member of staff received a needle stick injury in a resident’s room, where a needle had been left. During the morning medication round residents were seen given their medication and observed taking it, although on one occasion the drugs trolley was seen left open whilst unattended. Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 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, 13, 14 and 15 Residents are free to move around the home if they wish. Catering arrangements do not meet the preferences of residents. EVIDENCE: Daily life and social activities were not part of the main focus of this inspection, however residents who were mobile were seen moving around the home as they wished. A television was on in both lounges. Residents were seen reading and holding conversations. Visitors are welcome to the home and can visit at any time. A new cook had started this week, who had previously worked elsewhere in the home. The cook was not working to a menu and there was no choice of meal at lunchtime. Portions are not varied to suit the individual’s appetite and one resident who said she couldn’t eat all that was on her plate was told to eat what she could. A cooked breakfast is provided each day (tomatoes on toast was seen being served). The care plan of one resident referred to the resident liking Indian food, however there was no record to show that this is provided. Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 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): None EVIDENCE: Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 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): 19 and 21 A quicker response is needed to maintaining the physical standards in the home. EVIDENCE: The environment was not part of the main focus of this in section, although the following was noticed. There were some chairs in communal areas that were in a poor condition and these need to be recovered or replaced. In the residential area a toilet has been removed from an ensuite because it was damaged, which has not been replaced. Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 14 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 More importance needs to be given to ensuring the required number of staff are on duty. EVIDENCE: It was established that in order for the home to run safely and meet the needs of residents there should be 8 care staff and 2 trained nurses on duty each shift. There should be 3 care staff and a trained nurse on each floor and a further 2 care staff on duty in the area where residential residents stay. This level of staffing is not always adhered to but it was not possible to determine the frequency that this does occur. A record should be made of any occasion where this staffing level is not adhered to, to enable careful monitoring of staffing levels. Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 15 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): 32 and 38 The low morale within the staff team is affecting the service given to residents. Then health and safety of staff coming and leaving work has not been considered. EVIDENCE: There were a number of references made during the inspection to the low morale of the staff team and examples given of issues that staff were unhappy about The home is reached by using a secluded road, which although there is some street lighting on, this is regularly not working as a result of damage. Staff expressed concerns for their safety at walking along this road, particularly in the dark. There is no risk assessment for accessing the home and one should be prepared. The accident book in use does not comply with current legislation and one that does is needed.
Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 16 In the corridor on the first floor there is a break in the handrail provision over a radiator. Residents were seen using the radiator to compensate for this and full handrail provision is needed. Cleaning materials are kept in a locked cupboard, but the main material in use is not being dispensed correctly, it is intended to be used with a gun dispenser but there is not one available in the home. This should be dispensed using the correct equipment. Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 17 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 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X 2 X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 1 X X X X X 1 Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes – still within timescale of action plan 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 2 3 Standard OP7 OP8 OP8 Regulation 15 12 12 Requirement Ensure that care plans are accurate, kept up to date and involve residents Ensure that any dressing is changed when needed Introduce a procedure for shaving residents that includes not sharing toiletries and a suitable shaver is used chosen where able by the resident Investigate the needle stick injury Keep the drugs trolley locked when unattended Review current catering arrangements and ensure that preferences are catered for Repair or replace torn chairs in communal areas Replace the toilet removed in the ensuite Ensure the required number of staff are on duty and keep a record of any occasion that this does not occur. Address the issue of low morale within the home Prepare a risk assessment for staff for accessing and leaving
DS0000039367.V255303.R01.S.doc Timescale for action 01/02/06 06/10/05 01/12/05 4 5 6 7 8 9 OP9 OP9 OP15 OP19 OP21 OP27 13 13 16 13 23 18 01/11/05 06/10/05 01/02/06 01/03/06 01/12/05 06/10/05 10 11 OP32 OP38 10 13 01/01/06 01/11/05 Kingsthorpe View Care Home Version 5.0 Page 19 12 13 14 OP38 OP38 OP38 17 13 13 the home on foot Provide an accident book that meets current legislation requirements Provide a handrail over the first floor radiator Comply with correct dispensing arrangements for cleaning materials 01/11/05 01/12/05 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kingsthorpe View Care Home DS0000039367.V255303.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Nottingham Area Office 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
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