Inspection on 27/11/06 for Kingston Care Home

This inspection was carried out on 27th November 2006.

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

Kingston Care Home 05/06/07

Similar services:

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Kingston Care Home Jemmett Close Coombe Road Kingston Surrey KT2 7AJ Lead Inspector Margaret Lynes Key Unannounced Inspection 14.05p 27th November 2006 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 Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingston Care Home Address Jemmett Close Coombe Road Kingston Surrey KT2 7AJ 020 8547 0498 020 8547 0499 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) Four Seasons (No 9) Limited Mrs Veronica Scates Care Home 67 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Physical disability over 65 years of age (0) Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 24 service users in the Dementia - over 65 (DE(E)) category 43 service users in either the Old Age (OP) category and/or Physical Disability over 65 years of age (PD(E)) category. Date of last inspection Brief Description of the Service: Kingston Care Centre is a purpose built nursing home, constructed in 1997. The home provides care for up to 67 service users, and bedrooms are spread over three floors. The ground floor caters for 19 frail, elderly clients, as does the first floor, which has 24 beds. The top (second) floor caters for 24 elderly service users suffering from dementia. All of the bedrooms are single and ensuite. The home is situated opposite Kingston hospital, and only minutes walk from a rail station with frequent services into the centre of London. It is also conveniently placed for local bus services. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of 6 hours, and consisted of examining paperwork, a tour of the communal areas of the home and meeting with service users and staff. All of those who assisted with this Inspection are thanked for their efforts. The last inspection, in December 2005, had indicated that there were seven outstanding requirements. At this visit, five of these had been met, while one area had improved, albeit the required Standard had still not quite been reached. Two new requirements have been made. These relate to risk assessments and staff recruitment. Three recommendations have also been added. Evidence to support the comments below was gathered from a range of sources – the service users themselves, members of staff and inspection records. What the service does well: What has improved since the last inspection? The previous inspection report contained requirements regarding the need to ensure all service users had an up to date moving and handling assessment; the need to ensure waste bins (in bathrooms/WC’s) were fitted with lids; the need to ensure all extractor fans were regularly cleaned; the need to repair a tap on the second floor (WC); the need to ensure that all food that was opened and put in the fridges (one on each floor) had been dated; the need to ensure that medication administration records were accurately completed at all times and the need for the home to be provided with administrative support. As mentioned above, all but two of these have now been met, and one has been partially met. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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 Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable) Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. All of the files inspected included a pre-admission assessment. This means that the service user and their relatives can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: The files of six service users were inspected. All of them contained a detailed assessment from the placing Authority, and these were supplemented by the home’s own admission form. In three cases, staff had also completed a social needs assessment. This will be discussed further in Standards 12-15. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service user plans seen adequately covered the health, personal and social care needs of the service users. This means that the staff team are aware of the differing needs of their residents, and know what specific care needs to be given. Staff ensure that each resident is able to access community based health facilities as and when required. With two exceptions, the service user plan was supplemented by a number of health assessments, which means that in most cases the staff team are aware of the health needs of each individual service user and can plan their care accordingly. The medication administration records for one of the floors were examined. While most of the recording was satisfactory, unfortunately two errors were noted. Clearly this is unacceptable, as any mistakes made in giving out medication can have serious consequences for the service users. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 10 From observation and discussion, service users were treated with respect, and their right to privacy was upheld. EVIDENCE: A service user plan was found in each of the files inspected. These were well written and comprehensive, and indicated that staff had a good understanding of each individual service users’ needs. It was particularly noted that the care plan for one resident who had been in the home for just three days was extensive, and the author is to be commended. Almost all of the aforementioned files contained risk, moving and handling, nutrition, continence, pressure area and dependency assessments. One just one of the files inspected, however, the assessments re risk and continence had not been completed. The previously made requirement with regard to moving and handling assessments had been met. A requirement had been made in the previous two reports re the need for staff to ensure that medication administration records were accurately completed at all times. On this visit, while improvements were noted, there were still some errors found. These related to one service user being given an additional nutritional supplement – over and above that prescribed, and one chart that had not been clearly written by staff – leading to some ambiguity regarding whether the medication was to be given on a regular basis or as required. It was also noted that one two occasions it appeared that staff had signed the chart in advance of medication being given, as their signature had then been overwritten with the code to indicate that the drugs had not been administered. Staff must make every effort to ensure that they comply with established good practice, and, not least, with NMC guidelines. It was noted that the main, wall mounted metal drugs cabinet could not be locked. The manager explained that they were awaiting delivery of a new unit. A requirement has not, therefore, been made in this respect. Several service users were spoken with. None raised any concerns with regard to the care being provided. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a designated activities co-ordinator who provides a sufficient amount of stimulation to satisfy the service users social and recreational interests. Several service users met with the Inspector. From discussion and observation it was felt that they were enabled to exercise choice and control over their lives to the extent that it was possible. Visitors are encouraged to call. The menus were examined and appeared to offer a good selection of meals. Service users said that generally they found the food to be good. EVIDENCE: Some time was spent talking with the activities co-ordinator with regard to the variety of activities that were available. There appeared to be a good range, Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 12 including film shows, painting, cookery classes, hairdressing, flower planting, quizzes, external musical entertainers and outings. Service users can also attend a nutrition committee, residents meetings, Friends of Kingston Care meetings, and, indeed, relatives meetings. This is a vast improvement on that observed at the last inspection, when the activity co-ordinator’s position was vacant, and almost all of the relatives/residents spoken with felt that the home was failing in this respect. Mention has been made in Standard 3 of social needs assessments. While every service user plan inspected contained reference to social care needs, in some files staff had been able to complete an in-house proforma, which gave detailed information regarding the individuals likes, dislikes and preferences. This is good practice and staff should continue in their efforts to complete this proforma. Although a meal was not observed, the menus were provided and they indicated that there was a choice of meal each day. One service user bemoaned the fact that she had been unable to eat all of her supper – she was unhappy to have left some because, she stated, the food was delicious! The only issue with regard to food was the failure by staff to date any food that they opened and then stored in the fridge. Relatives are made welcome, and a number were seen to be coming and going during the day. One kindly took the trouble to come up to the Inspector to say hello and confirm that he continued to be very happy with the home, and, in particular, the way it was managed. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. All concerns are logged, followed up and audited. In this way service users, their relatives and friends can be confident that their complaints will be listened to, taken seriously and acted upon. The home has a satisfactory adult protection procedure in place. This means that as far as is possible, service users are protected from abuse. EVIDENCE: As mentioned above, every concern that is raised, no matter how small or trivial it might seem, is logged as a complaint. This meticulous recording is reflected in the number of ‘complaints’ that have been logged since the last visit – 68. A monthly audit is carried out and a month-by-month analysis is provided. All complaints are logged centrally, with a summary sheet for easy reference. The home has its own in-house adult protection procedure, and a copy of the Local Authority multi-agency procedures is also kept. Examination of staff training records indicated that training in the prevention of abuse was seen as one of the key training areas. Eight staff files were examined and all but the two newest employees had attended POVA training. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The parts of the home seen were in a good state of repair, and it was felt that the home provided a safe and well-maintained environment. The communal areas were clean, pleasant and hygienic, as were the bedrooms that were visited. EVIDENCE: A walk was taken around the home, with a number of the communal areas and some of the bedrooms visited. All of these areas were clean and in a good state of decoration and furnishing. The environment was pleasant, and efforts had been made to make it more homely and less clinical. The Christmas decorations were particularly attractive. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 15 The last inspection had resulted in three requirements being made with regard to the premises. These concerned the need to ensure that the waste bins in the bathrooms/WC which should have lids did have them; the need to repair a tap in one of the second floor WC’s, and the need to ensure that all extractor fans were regularly cleaned. All of these requirements had been met. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The number of staff on duty, both qualified nurses and care assistants, appeared to be sufficient. This means that service users should be attended to promptly, and their needs met. Recruitment procedures were not robust enough to adequately support and protect service users. Staff are able to access a variety of in-house training courses, and these are put on at regular intervals. This means that the staff team should be competent to do their jobs. EVIDENCE: The rota for one week was assessed. This showed that on each day shift there were usually 4-5 qualified nurses on duty in the morning, with 9-11 care assistants (there was one exception to this when there were just 3 qualified nurses on duty); 3 qualified staff with 10 – 11 care assistants on duty in the afternoon/evening; and 3 qualified staff with 3 carers on duty overnight. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 17 The files of eight staff were examined. While most of them contained the documentation required, there were some notable, and unacceptable, omissions. One file contained only 1 reference, while 3 were missing a recent photograph. Of most concern was the apparent employment of some staff without waiting for their CRB check to be returned, and no evidence that a POVA 1st had been sought. Clarification about this was requested and it transpired that two of the staff had been on a week’s training course, not in the home, and had only started actual work at the home when their CRB’s had been returned. One other new staff member had started with just a POVA 1st, however there was nothing to confirm this on their file. While it is acknowledged that the company has now stated that it will no longer allow staff to start without a full CRB, where such practice has taken place, or where staff are on training courses prior to commencing work with service users, it is strongly recommended that a note of this be entered onto their file. Staff are able to access a variety of training courses, including dementia care, catheterisation, wound documentation, care planning, infection control and venepuncture. ‘Mandatory’ training in areas such as health and safety, manual handling and adult protection is ongoing. Three staff have obtained NVQ qualifications at level II and/or III, while a further 8 are waiting for NVQ II results. While this is positive, it must also be noted that the number of care staff with an NVQ award is considerable below the 50 benchmark given in the National Minimum Standards. A detailed and comprehensive induction programme has just been introduced. It is anticipated that it will take new employees some 8-12 weeks to work through, and it is linked, where possible, to NVQ modules. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are enabled to live in a home that is managed well and is being run in the best interests of the service users. There is a comprehensive quality assurance system in place, which enables the management to identify any areas where the service is sub-standard and then take action to improve it. This means that the home is run in the best interests of the service users. Service users financial interests are safeguarded. All their monies are banked centrally and then service users are invoiced for any items they purchase. All of the necessary maintenance checks had been carried out, albeit the check of portable electric equipment was due to be carried out. This means that the Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 19 health, safety and welfare of both service users and staff is promoted and protected. EVIDENCE: Since the last inspection visit the manager has completed the Registered Managers Award, and is awaiting the certificate. Comments from service users and relatives indicated that they thought the home was well run and well managed. The manager conducts a number of regular audits to monitor the performance of the home against its Statement of Purpose. For example, on a monthly basis audits of accident reports, staff training, complaints, health and safety, pressure sores and medication are carried out and clearly documented. Since the last inspection the home has moved the recording of service users monies from a paper system to a computerised system. Every month service users are provided with a statement to indicate the state of their finances. Comprehensive maintenance records were being kept, and all of the necessary regular checks were up to date, with the exception of the portable electrical equipment, the check of which was due around the same time as this inspection. It was also noted that the home maintained a log of checks of the fire escape exits, but while the guidance stated that the checks were to be carried out weekly, the log indicated that no such checks had taken place between May and November. This should be rectified. The accident record showed that there had been a high number of (service user) falls in the home – between 10 and 35 a month. This is exceptionally high, and has been raised as a concern by the Inspector on previous occasions. It is felt, however, after discussion with the manager, that all proactive measures are being taken, and after each incident staff look to see if there was more that they could have done to prevent the fall occurring. Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 21 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. 2 Standard OP9 Regulation 13 Requirement The manager must ensure that medication records are correctly maintained at all times. The previously set timescale has again not been fully met. Staff must ensure that they date label all cartons of juice, and cover and date all other foodstuffs in the fridge, to indicate when they were first opened. The previously set timescale has again not been met. All service users must have an up to date risk assessment. All new staff must provide the required documentation before commencing work in the home. Timescale for action 27/11/06 3 OP15 16 27/11/06 1 2 OP8 OP29 13 19 30/11/06 27/11/06 Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 22 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 OP28 OP29 Good Practice Recommendations Concerted effort should be made to bring the number of care staff with an NVQ award up to the 50 recommended in the Standards. It is recommended that a record is made when staff commence employment with the home, but spend the time until their CRB check is returned away on a training course. It is strongly recommended that the home abide by its own fire safety procedures and check emergency exits on a weekly basis. 3 OP38 Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kingston Care Home DS0000068285.V316295.R01.S.doc Version 5.2 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. 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