Inspection on 08/03/08 for Kingston Nursing Home

This inspection was carried out on 8th March 2008.

CSCI found this care home to be providing an Adequate service.

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 Nursing Home 09/02/09

Kingston Nursing Home 27/02/07

Kingston Nursing Home 16/02/06

Kingston Nursing Home 15/09/05

Kingston Nursing Home 20/10/04

Kingston Nursing Home 15/07/04

Kingston Nursing Home 16/01/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Kingston Nursing Home Kingston House 7 Park Crescent Leeds Yorkshire LS8 1DH Lead Inspector Sean Cassidy Key Unannounced Inspection 8th March 2008 09:00 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 Nursing Home DS0000001349.V360756.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 Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingston Nursing Home Address Kingston House 7 Park Crescent Leeds Yorkshire LS8 1DH 0113 2666520 0113 2664171 kimmahachi@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) B & C Holt Limited Mrs Kim Mahachi Care Home 37 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (37), of places Physical disability (1) Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for PD is for the service user named in the variation application dated 3 April 2006 One specific service user in the category DE, named on variation dated 2nd February 2007, may reside at the home. 27/2/07 Date of last inspection Brief Description of the Service: Kingston House is a thirty-seven bedded care home for older people situated in the north of the city of Leeds and provides nursing care. The bedrooms are located over four floors; these are accessed by a passenger lift and are a mixture of single and double rooms. Assisted bathing facilities are available as is other specialised equipment. The home operates a no smoking policy. The home is off the main road but regular bus services are in operation. There is parking available at the home for visitors with cars. There are gardens to the front and side of the building and a conservatory has been added to the rear. The fees charged for care provision at the time of the inspection ranged from £534:66 to £615. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence in this report has included: • • A review of the information held on the home’s file since the last inspection. Information obtained from residents, relatives, staff and other health care professionals. Two inspectors and an Expert by Experience conducted an unannounced visit to the home, which lasted one day. The majority of this time was spent observing care provision, speaking to residents, management, staff and relatives. The visit included a tour of the premises. A number of documents were examined which included care files, training files, and health and safety details. The information required from the provider in the form of the Annual Quality Assurance Assessment (AQAA) was provided prior to the inspection and information from this is also included in the report. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: Relatives said that they were provided with good information to help them make their choice of moving into the home. Most staff were observed to be kind, caring and attentive to residents needs. The systems and training in place to help protect the resident group are good. The standard of cleanliness in the home is good. The recruitment process adopted by the home is good and helps to ensure residents are protected. The management team are very helpful and supportive to all stakeholders. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Statement of Purpose should be changed to ensure up to date information about the care needs of the resident group living in the home is available. A more person centred care approach should be taken when developing the care plans for people living in the home. This will provide staff with a more robust and informative picture of how each individual’s needs can be met. The manager must ensure staff are quicker to respond to the changing health needs of the residents when this is identified. This will help to ensure action can be taken to provide for that need. The manager must ensure that risk assessments and care plans are developed to ensure staff are fully informed as to how to manage and provide for a care need. An example of where this was a concern was in relation to a resident having a very challenging behaviour but there was no care plan or risk assessment to assist staff to manage this problem. The manager must ensure that evidence is in place to show there is a wellstructured activities programme that takes into account the wishes and views of the people living in the home. Particular attention is needed for those residents with specialist dementia and other cognitive needs. The cultural needs of residents must be clearly identified and provided for. This will help provide individuals with a sense of well-being. It is recommended that the dining areas be more regularly used to promote better social interaction between residents and others. This will help promote well-being for residents. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 7 It is recommended that the home try to adapt the environment so that it is more appropriate for people who have specialist dementia and cognitive needs. It is also recommended that a health professional such as an Occupational Therapist assist with this process. The manager must ensure that the safeguarding referral process is correct and that all safeguarding issues are properly dealt with. This will help to ensure residents are properly protected The manager must review the safeguarding training. This will help ensure all staff have a better understanding of what constitutes abuse and what they must do to protect people when this is identified. 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 Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service experience good quality outcomes in this area. Prospective residents are assessed prior to moving into the home and are provided with information to help them make their choice. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The Service User Guide and the Statement of Purpose have recently been reviewed and improved. Each resident is provided with this information at the point of entry to the home. These documents were seen in two residents’ rooms during the inspection. Three relatives spoken to said they felt they were Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 10 provided with the right amount of information to assist them with making the decision to move into the home. However, during the inspection, it was clear that the majority of people living in the home have some form of dementia or other cognitive problems. The Service User Guide and Statement of Purpose do not clearly reflect this. The absence of this information means prospective residents and their families are not fully informed about this specialist care need provided in the home. The admission documentation for two residents was seen and staff had obtained assessment information prior to admitting them to the home. This helps to ensure the person’s needs can be met by the care service. One resident was admitted using an assessment that was three months old and had not been reassessed on admission. The absence of an up to date assessment could mean that his care needs have not been properly identified and provided for. Two relatives spoken to about their experience of the admission process gave positive feedback. However, one did say that she was not provided with an opportunity to come and look around or that her relative could come and visit prior to moving in. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service experience adequate quality outcomes in this area. Although improvement was seen in care planning there are still areas that need further improvement to ensure health care needs of people are met. A more person centred care approach is needed to ensure residents choice and independence is promoted at all times. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The care files of three residents were closely inspected. All had care plans which identified the care to be given by care staff to meet individual needs. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 12 Two out of the three files contained evidence that the resident or their representative had been involved with agreeing to the planned care. Each file contained a picture of the individual. This is good practice as it helps give the person a sense of identity and ownership with the care file. Evidence was seen that showed other professionals see people regularly. These include GPs, opticians and community nurses. Two residents and three relatives said they were happy with the way the home provided for health care needs. Each care file contained evidence to show people are risk assessed in areas such as nutritional status, pressure area, falls and moving and handling. Not all care needs were responded to appropriately which means residents may not receive the correct care. Examples of this are: • One resident’s file showed that the person had lost just under 2kg in weight in one month but the risk assessment had not been altered to reflect the change in risk. This nutritional change was not reflected in the pressure area risk assessment. This placed the resident at risk. One resident was identified as having lost 10kg in less than three months. There was no evidence that this had been acted upon. The pressure area risk assessment identified that this person had no issues with nutrition when that was clearly not the case. This in turn meant the pressure area risk assessment was incorrect and placed that person at risk. The care plan for a resident identified as having a sacral pressure sore did not inform staff that the person’s position needed to be altered at different times to relieve pressure. This person was observed over the course of the inspection and her position was not altered. This placed that person at risk. A person identified as being a risk to others due to his aggressive behaviour had no risk assessment or care plan in place to manage this. The daily records showed that this person had been aggressive during his stay in the home. This placed people at risk. The wound care plan for a resident showed staff had not been dressing the wound as instructed in the care plan. • • • • The manager has attempted to incorporate a person centred care approach into the care plans. She confirmed that her understanding of person centred care was not as substantial as it should be and that development was needed in this area. The care files do not contain clear information to show each individual’s wishes, choices and decisions have been taken into consideration when planning care. Staff spoken to were not fully aware of the information written in the care files Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 13 with regards to residents’ care needs. Staff spoken with were not familiar with person centred care and what the benefits of this were to people with specialist dementia needs. Further discussions with the manager and staff demonstrated a lack of understanding of people with dementia care needs. The inspectors had to provide examples of best practice relating to dementia care. The absence of this knowledge means people living in the home are not receiving the specialist care they need. The relatives spoken to during the day and also contacted by surveys expressed that they were overall happy with the care their family members were receiving in the home. They said the staff were responsive, friendly, helpful and caring. The staff were observed providing care to people over the course of the day. There were many examples of good positive interactions between staff and residents over the day and there were also examples of negative interaction. Examples of good practice seen were: • • • • • People being talked to in a kindly manner. A resident was given personal intimate contact from a carer that was positively responded to. Two staff sitting beside residents and chatting. Staff responded to peoples needs quickly. Residents looked clean and generally well dressed although it appeared that not everyone had had their hair brushed or combed. Examples of negative interaction were: • • Two people who continually called out were ignored on several occasions. The television was turned on in both lounges. The volume was loud and annoying. One resident spoken to said, “The television is just on. I don’t watch it.” When staff were asked how they knew people wanted to watch the television they did not know. People were sat in chairs with side tables placed close in front of them, which appeared restrictive. This showed a lack of consideration for residents’ comfort. At least three people were seen transported in wheelchairs with no cushions. This demonstrated a lack of consideration to residents’ comfort. Most women had pop socks whether wearing a dress skirt or trousers. This resulted in some bare legs being exposed and looked unsightly DS0000001349.V360756.R01.S.doc Version 5.2 Page 14 • • • Kingston Nursing Home and undignified. Care plans did not show evidence that this was their choice to wear these. Medication systems were reviewed and these showed that there has been an improvement from the last inspection. Consent has been obtained for the majority of residents whom the home medicates for. The medication charts were reviewed and these were filled in consistently. There are no residents living in the home that self medicate. The home has a self-medication risk assessment in place to assist this process. It was recommended that the manager use this assessment for all new residents. The assumption that all residents are able to medicate themselves should be taken. The risk assessment will assist the home and other parties to decide whether this is safe to do so. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 15 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): 11, 12, 13 and 14. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service experience adequate quality outcomes in this area. The social, cultural and recreational needs of people living in the home are not consistently met. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The Annual Quality Review form completed by the manager stated that residents find the lifestyle experience in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. They can maintain contact with friends, family and local community. We have an open visiting policy. Relatives can take their loved Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 16 ones out at any time when health and weather permits. The list of activities displayed in the hall was out of date. There was little evidence to show that the daily routines support people with dementia care needs or other cognitive impairment to be involved in planning or having control over their day-to-day activities. The manager gave examples of different entertainment being brought into the home. Games such as bingo and skittles are also played regularly. Evidence was seen to show religious services are provided on a regular basis and that these are well attended. There is a separate lounge where residents can get away from other people, but this is not easily accessed due to having to use a lift or steep stairs. There is no easily accessible secure garden, which is designed to include scents and possibly enable residents to grow plants and vegetables. Some residents are taken out on trips outside of the home. These trips are for those that are able to mobilise more easily. There was little evidence provided to show residents who are less able are provided with regular social opportunities outside of the home. The daily records showed no evidence to show what activities the person was involved with on a daily basis. A co-ordinator organises activities two days a week. There are long periods of time (including evenings and weekends) when nothing structured is happening. One person said, “We just sit and wait for meals.” Residents said they do have ‘trips out’ from time to time and a member of staff said, “We do use the garden in the warmer weather.” Two residents said, “we just go to bed early – there is nothing else to do.” The cultural needs of one resident were closely inspected. It was clear that this person had a very clear and strong attachment to his country of birth and the care plans identified this. However, there was no plan of care to show how staff were to provide for these cultural needs. One care plan said he liked to listen to the music from his country. The CD player in his room was broken and had been for some time. His room showed no visual reminders of his country of origin and there was no evidence that activities were developed for him to provide for this need. The lunchtime meal was observed. There were some good interactions observed between staff and the residents that were being helped with their food, but there were also some negative interactions seen. The relatives spoken to during the inspection said that they thought the meals served in the home were of a good quality. During the morning a member of staff spoke with each resident offering them the choice of two cooked meals of equal value. There was no recognition that this way of offering choice to residents with dementia care needs and other Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 17 types of cognitive impairment e.g. memory loss is inappropriate and provides limited opportunity for the resident to make a positive choice. Ethnic appropriate meals were being served but the chef explained that he finds it difficult to do this more than twice a week. One resident said the meals aren’t what she would have enjoyed at home, saying she would very much like a “little salmon with some vinegar on”. Another said she had been asked about preferences and she had expressed a wish to have a Chinese takeaway meal occasionally but hadn’t been offered one – “ I think I would have a nice mild chicken curry”. Both of these residents said they were “sick of sandwiches at tea time.” One resident said, “Meals are pretty good but I really hate eating my meal from a tea plate.” One resident was provided with buffet food to accommodate her unsettled behaviour. This is good practice. Some residents required assistance with eating their meals and it was observed that staff did not generally achieve good interactions or eye contact when helping. One member of staff ‘fed’ two people at the same time and left halfway through to carry out another job. The meal was served in the lounge. Residents remained in their lounge chairs and were provided with a table. Residents were not offered the opportunity to sit at a dining table. This was also the case in the lounge in the upper area of the house. The dining facilities do not lend themselves to enabling everyone the opportunity to do this. The main dining room accommodates 12 residents and there is a table off the lower ground floor lounge which seats 4. This table is positioned in a walk through area. Some meals were taken upstairs on a trolley. The food was uncovered allowing it to cool further before reaching the resident. Meals were plated by the cook and handed out. Staff handed out a choice of cold drinks. Residents were not provided with condiments. The mealtime experience provided no opportunity for residents to exercise real choice or be independent. To promote choice and independence consideration should be given to actively enabling residents to serve themselves at the table. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. People who use the service experience adequate quality outcomes in this area. People living in the home are not fully protected by the safeguarding systems used by the home. This places them at risk. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: There was no record of any complaints. This correlated with the Annual Quality Review (AQAA). No complaints have been sent to the CSCI and therefore no assessment could be made about how complaints are dealt with. The Complaints procedure is displayed in the hall and is provided in the Service User Guide. It provides inaccurate information about how to contact the Commission for Social Care Inspection (CSCI) and misleading information about the role of the CSCI in responding to complaints. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 19 The AQAA states that the residents are protected from all forms of abuse and that outside agencies are contacted to seek help and advice. However, evidence found showed that the safeguarding procedure used by the home has not been followed on at least two occasions. The manager had recently contacted the CSCI about a safeguarding issue. The information provided and conversations with the manager showed that the internal policy had not been properly followed, which placed people at risk. One other safeguarding incident was identified during the inspection. The manager did not feel that this was a safeguarding incident and no records were kept in relating to it. It was recommended that this matter be referred to the safeguarding team for advice. There was evidence obtained to show staff are provided with training in safeguarding. However, three members of staff spoken to were ill informed about what to do if an allegation of abuse was reported to them.They did not fully understand what constituted abuse and what their role was if they identified it. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 20 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. People who use the service experience good quality outcomes in this area. The standard of cleanliness in the home is good. Alterations to the environment should be made to make it more suitable to people with specialist dementia and other cognitive needs. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: People spoken to said that they were very happy with the environment. This feedback was mostly received from relatives. They liked the setting and the standard of the internal decoration of the home. Some comments made were, Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 21 “Its always clean and tidy. That’s the way mum would like it.” “There are no smells in the home, which helps.” “The home offers a welcoming, comfortable atmosphere.” Although the internal layout of the home is made accessible to all, there appeared to be few considerations given to environmental issues that help people who have cognitive impairment or dementia care needs to be more independent. Environmental issues were discussed with the manager with regards to good practice and assurances were given that these would be looked at in the near future. It was recommended to the manager that she enlist the help of another professional to assist her with providing a environment that is more suitable to people with specialist dementia and other cognitive needs. There are large gardens that are accessible to residents. These are not enclosed gardens and therefore are not accessible for people with dementia to wander unaccompanied. People said that some residents do access the gardens and they are well used during the summer. They also said fetes are put on during the summer months. The home offers a welcoming comfortable atmosphere and residents are able to access all areas of the home. The rooms and other areas of the home that were visited appeared clean and tidy. The sluice and laundry facilities appeared well managed. There were some areas of the home that had a malodour and these were pointed out to the manager to look into. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 22 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, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service experience good quality outcomes in this area. There are suitable numbers of trained staff available to assist people with meeting their care needs. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: During the inspection held at the premises the staffing levels appeared to be appropriate for the care needs of the people living in the home. The staff did not appear rushed in any way and had time to respond to people when they asked or gave an indication that they needed assistance. The staffing rotas were looked at and were in good order. The recruitment process is robust and minimises the risk of employing unsuitable people. All pre employment checks are carried out and evidence was provided to show all the appropriate checks were carried out and Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 23 information obtained prior to commencing work. There were no interview notes to evidence that a face to face interview takes place. The manager gave assurances that they do. Staff spoken to and staff contacted by all said that they had an induction when they started working in the home. No evidence could be provided by the manager to show induction had actually been provided. One person started work in the first week of December 07. She has to date had no induction training or any other type of training. The manager explained that she has been absent from work for about four weeks in this time. All staff spoken to and also those that returned their surveys provided evidence to show training is provided. Training files showed that staff receive all the mandatory training e.g. fire,first aid,Moving and Handling etc. Other specialist type training is provided eg Dementia Care, Abuse awareness,end of life care etc. Information provided by the manager confirms that 75 of care staff have completed National Vocational Qualification level 2 in care. Remaining staff are enrolled to start the course.One staff has completed NVQ level 3 with one other person working towards it. Agency staff are never used. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 24 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. People who use the service experience good quality outcomes in this area. People living in the home benefit form good management systems and processes. We have made this judgment using a range of evidence, including a visit to the service. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is qualified and experienced in managing care services for older people. Good positive feedback was received from relatives and staff about the way the manager works. They all said she was very approachable and was responsive to any issues that they raised with her. Discussions held with the manager did highlight a lack of knowledge about current best practice in delivering a service to people with dementia care needs. The inspectors had to provide numerous examples of best practice. The manager acknowledged this gap and said that there are significantly more people in the home with specialist dementia needs now compared to in the past. This knowledge gap must be addressed to ensure the specialist needs of the residents are met. Management use a professional quality assurance system to measure quality. It is a systematic approach to all the tasks and activities carried out by staff, which have a bearing on the quality of service provided at Kingston Nursing Home. Relatives are surveyed as part of this process and the first relatives meeting is about to be held. The manager explained that residents are not surveyed and do not have meetings due to previous lack of interest.Management then analyse the results, which informs the development plan for the following year. The plan for 2008 has not yet been written. A senior manager of the company visits at least monthly and usually more often. A report commenting on the conduct of the service is completed following the monthly visit. The service does not hold any of residents money for safekeeping.Family or the local authority mange residents financial affairs. Management seek to promote the health safety and welfare of residents through a range of procedures that guide staff practice. Regular maintenance and servicing of equipment is carried out alongside monthly safety checks. A risk assessments of the premises is completed. Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 26 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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Care plans and risk assessments must be developed and followed to ensure the care needs of residents are met. Timescale for action 31/05/08 2 OP8 15(2)(b) The manager must ensure that 31/05/08 when a resident’s care need changes then staff respond to it quickly. (This refers to the nutritional issues identified in the report) This will ensure resident receive the correct care at the correct time. The manager must ensure that evidence is in place to show that there is a well-structured activities programme that takes into account the wishes and views of the people living in the home. Particular attention is needed for those residents with specialist dementia and other cognitive needs. The cultural needs of residents must be clearly identified and provided for. This will help provide individuals with a sense of well being. DS0000001349.V360756.R01.S.doc Version 5.2 Page 28 3 OP12 16(m)(n) 31/05/08 12(4)(b) Kingston Nursing Home 4 OP18 13(6) The manager must ensure that the safeguarding referral process is correct and that all safeguarding issues are properly dealt with. This will help to ensure residents are properly protected The manager must review the safeguarding training and ensure all staff have a good understanding of what constitutes abuse and what they must do to protect people when this is identified. 30/04/08 5 OP26 12(2) The manager should ensure all parts of the home are free from offensive odours. 31/05/08 Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations The Statement of Purpose should be reviewed to include up to date information about the specialist dementia care needs of the people living in the home. The care plans should be reviewed and made more person centred. Training is needed to ensure this can be developed. This will ensure people receive an appropriate individualised care package. The manager should ensure all new residents entering the home are assessed to check whether they are able to self medicate or not. It is recommended that the dining areas be more regularly used to promote better social interaction between residents and others. This will help promote well-being for residents. It is recommended that the home try to adapt the environment so that it is more appropriate for people who have specialist dementia and cognitive needs. It is also recommended that a health professional in this area assist with this process. 2 OP7 3 OP9 4 OP15 5 OP19 Kingston Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Nursing Home DS0000001349.V360756.R01.S.doc Version 5.2 Page 31 - 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!