Inspection on 17/05/05 for Kingswood Court

This inspection was carried out on 17th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kingswood Court 11/07/07

Kingswood Court 27/02/07

Kingswood Court 20/10/05

Kingswood Court 19/11/04

Kingswood Court 17/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Kingswood Court Warren Lodge Drive Kingswood Surrey KT20 6QN Lead Inspector Janet Daulton Unannounced 17 May 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kingswood Court Address Warren Lodge Drive, Kingswood Surrey KT20 6QN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 830480 01737 830374 Balcombe Care Homes Ltd Mrs Ann Sayers CRH Care Home 44 Category(ies) of DE(E) Dementia - over 65 - 6 registration, with number OP Old Age - 44 of places PD Physical disability - 2 PD(E) Physical disability - over 65 - 4 Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Of the 44 (forty-four) registered, 6 (six) service users may be within the category DE(E) and 4 (four) may be within the category P(E) Date implemented - 22 August 2002 Upto 36 (thirty-six) of the 44 (forty-four) registered beds can be used for Acute and Continuing Care Date implemented - 18 February 2003 Of the 44 (forty-four) registered service users, 2 (two) may be within the category PD (between the ages 55 and 65) Date implemented 18 September 2003 Service users requiring acute or continuing care must be accommodated on the ground or first floor only. Date implemented 20 December 2004 Date of last inspection 19 November 2004 Brief Description of the Service: Kingswood Court is a large property which has been adapted to provide nursing care and accomodation for up to 44 service users. It is situated at the end of a private driveway,off the A217, within easy reach of the M25. There are no local shops or other amennities close by. Accomodation is situated in the main house, and an attached unit , the Kingfisher Unit. There are 34 single rooms, and 5 double rooms; 3 single rooms and 3 double rooms have ensuite facilities. There are communal areas in both parts of the home. The home has a large landscaped garden to the rear and ample parking facilities to the front of the property.The Registered Manager oversees the clinical practice and day to day administration of the home. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unnannounced inspection took place over 5 hours and was the first inspection carried out by the Commission for Social care Inspection for the year 2005-2006. The inspection was carried out by Janet Daulton, Lead inspector for the service. Mrs. Ann Sayers, the Registered Manager was present throughout the inspection. A tour of the premises took place. Six care plans, the complaints log, staff recruitment files, and a sample of safety certificates were inspected. The inspector spoke to 15 service users, 2 relatives and took lunch in the dining room with the service users. The inspector also spoke with some of the staff on duty at the time of the inspection. The inspector would like to thank the staff and service users for their time, assistance, and hospitality during the inspection. What the service does well: The home continues to provide a homely and attractive environment for the service users. The staff were seen to be caring for the service users in an open but respectful way. Service users said that the staff treated them well. Meals were varied, well balanced and nicely presented, offering a choice and variety. The service users care plans were detailed. They gave clear instructions to the staff about the service users needs and the care that had to be given to meet those needs. The home actively seeks the views of the service users, including regular service user meetings and questionnaires. All the service users get a copy of the report on their views Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 standard(s) 3,4 Service users have their needs assessed before they move into the home to ensure that the home can provide for those needs EVIDENCE: All the care plans inspected had a pre-admission needs assessment completed by the Manager of the home. The assessment covered all elements of physical, mental, and social needs. There was a training programme in place for staff, covering topics such as communication skills, foot care, diabetes training, and infection control. There was no specific training about caring for service users with dementia, and a recommendation was made. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 10, 11 The service users’ needs were set out in an individual plan with actions stated to meet the needs. There was written evidence that these were being met and there was a regular review of whether the needs had changed. EVIDENCE: Service users and relatives spoken with were complimentary regarding the care that they received in the home. One relative commented that she was kept fully informed about her mother and another service user stated that she felt fully involved and consulted about care that was given to her. Care plans were sampled and examined. These were detailed with risk assessments being completed. They were signed by the service users wherever possible. Two service users commented about occasional rough handling by the night staff. The manager was aware of this matter and this matter had been discussed in a staff meeting and action was being taken. There was evidence of pressure relieving equipment in the home. At the time of the inspection there was one service user with a pressure sore, which had been acquired in hospital. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 10 The home has detailed polices for the care of the dying person. The inspector discussed with the manager about sourcing access to bereavement counselling services. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 standard(s) 13,14 15 The service users were enabled to maintain their independence as much as possible. Catering arrangements were good and service users received varied and nutritious food, which was appropriately served. EVIDENCE: The full time chef oversees the catering arrangements. The choice of food offered was varied and appeared nutritious. A menu was displayed. The inspector took lunch with the service users in the dining room. All service users spoken with were satisfied with the quality of the food served. Visitors were able to call on the service users at any reasonable time. Several of the service users had regular visitors. Visitors who were in the home on the day of the inspection commented that they were always made to feel welcome. The service users stated that the home encourages them to be as independent as possible. They retain control over their financial matters as long as they are able, otherwise their families or advocates acts on their behalf. The service users are encouraged to personalise their rooms and several service users had brought in their own small furniture items. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 standard(s) 16, 18 The home has a simple and accessible complaints procedure, which includes timescales for the process. Training for all staff in abuse awareness must be implemented to protect service users. EVIDENCE: The home has a complaints procedure. There had been 6 complaints detailed since the last inspection. It was pleasing to note that the manager followed the complaints procedure even for minor concerns and all complaints were managed efficiently with a satisfactory outcome. Several service users and relatives spoken to during the inspection were aware of the complaints procedure, and felt confident about using the process. From records examined, only 13 members of staff had had abuse awareness training. The home must obtain the updated Surrey Multi agency procedures for protecting vulnerable adults. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 standard(s) 19,26 The location and layout of the home is suitable for its stated purpose. It is accessible, safe and well-maintained with a pleasant and homely atmosphere. EVIDENCE: During a tour of the home the premises were seen to be well maintained with service users able to access all areas of the home and grounds. On the day of the inspection the home was found to be warm and bright with a homely atmosphere and a good standard of housekeeping apparent. The manager stated that the previous requirement to repair the kitchen floor was being incorporated into the new building work, which was planned to start in the near future. The gardens were extensive and well maintained. Several service users commented about the lovely views of the garden. One service user commented on enjoying his daily walk in the garden. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The numbers of staff on duty during the inspection were sufficient to meet the needs of the service users. The recruitment process was being followed to ensure that only suitable staff were being employed. EVIDENCE: The staff rota inspected demonstrated that the staffing numbers and skill mix were appropriate to meet the assessed needs of the service users living in the home. Staff files of 2 new members of staff were examined at inspection. These contained the necessary checks and references. These members of staff had received induction training covering aspects such as moving and handling, fire training and elements of care. Service users were generally very complimentary about the staff at the home, stating “nothing was too much trouble.” All interactions observed between staff and service users during the inspection were seen to be caring and respectful. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 38 The home has effective systems in place to monitor the quality of care and services provided. Policies, procedures and practices are in place to ensure, as far as is reasonable practicable, the health, safety and welfare of service users, however the registered person must complete a general risk assessment for the home. EVIDENCE: The home has recently completed a full survey of all service users. The inspector was advised that the results will be correlated in to a report and all service users will receive a copy of the report. The inspector sampled some of the replies to the questionnaire. The inspector commends the management for their ongoing efforts in looking for ways to further improve the care and services offered to those living at the home. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 16 During the inspection the fire log, and accident book were inspected and found to be in order and up to date. Staff were observed to be following appropriate health and safety practices as they went about their work. The homes risk assessment was not available for inspection. This is an outstanding requirement from the last inspection. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x 2 x x 4 x x x x 2 Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 18 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 18.2 18.2 38 Regulation 12(1)(5) 12(1)(5) 13(4) Requirement All staff must have abuse awareness training The updated multi agency policy for protecting vulnerable adults must be obtained. A general risk assessment of the building and all safe working practices must be completed. This is an outstanding requirement from the last inspection. The kitchen floor requires repair. This is an outstanding requirement Timescale for action September 30th 2005 July 31st 2005 July 31st 2005 4. 19 23(2)(b) September 30th 2005 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 4.2 11.8 Good Practice Recommendations Staff training should include caring for service users with dementia. It is recommended that access to a bereavement counselling service is available. Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kingswood Court H58 h09 s13331 Kingswood Ct v228808 170505 Stage 4.doc Version 1.30 Page 20 - 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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