CARE HOMES FOR OLDER PEOPLE
Kingswood House Hollington Road Raunds Northants NN9 6NH
Lead Inspector Linda Lilley Unannounced Wednesday, 4th May 2005 15:20 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 House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Kingswood House Address Hollington Road Raunds Northants NN9 6NH 01933 624298 01933 626871 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) Kingswood Home Limited Claire Swailes Care Home 18 Category(ies) of OP Old Age (18) registration, with number PD(E) Physical Disability - Over 65 Years (5) of places DE(E) Dementia - Over 65 Years (5) Kingswood House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No one falling into the category DE(E) may be admitted into the home where there are 5 persons of category DE(E) already accommodated within the home 2. No one falling into the category PD(E) may be admitted into the home where there are 5 persons of category PD(E) already accommodated within the home. Date of last inspection 17th February 2005 Brief Description of the Service: Kingswood House is a care home providing personal care and accommodation for 18 older people over the age of 65 years to include 5 people with a physical disability and 5 people with dementia. Kingswood House is an established care home. The home is located close to the centre of the small town of Raunds within its own grounds.The home has 14 single bedrooms and 2 shared rooms. Bedrooms are located on the ground and first floors with a stair lift providing access to the first floor. The home has a large well maintained garden. Kingswood House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours in the late afternoon/ early evening. A partial tour of the home took place and staff, residents and visitors were spoken to. Some resident’s records and documents regarding the management of the home were looked at and observations of the interaction between staff and residents and care practices were observed. What the service does well: What has improved since the last inspection?
Effort has been put into improving the residents care records and some records did include more detail as to what was required of the carer. Advice has been obtained from a pharmacist regarding pre dispensing of medicines for residents on visits outside the home, and a robust system has been introduced that provides clear instructions for everyone involved. Over 50 of staff in the home now has an NVQ`level 2 or above qualification Kingswood House Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kingswood House Version 1.10 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 House Version 1.10 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) 12345 Residents and their families who use the service receive information to enable them to make a choice about whether or not they might want to live in the home. EVIDENCE: The homes Statement of Purpose and Service Users guide provides details of the services the home provides. There are minor shortfalls in relation to information for families and residents regarding the provision of staff escorts for residents to attend emergency or booked hospital appointments. Individual records are kept for each resident and the three sets of records examined included a full assessment of the residents needs and a written contract describing the terms and conditions of living in the home. Two residents and their families spoken to were able to describe the visits and trail period they undertook prior to choosing the home. Kingswood House Version 1.10 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) 7.8.9.10.11 There are minor shortfalls on ensuring residents healthcare needs are met. These shortfalls have the potential of placing the residents and the staff at risk. EVIDENCE: Individual plans of care are available for each resident. Three sets of plans were reviewed. In general they provided good guidance for the staff providing care. However they were not always up to date. This was particularly evident for one resident who had been admitted to hospital and then returned to the home and there was no record of any risk assessment and associated changes to the plan as a result of the residents changing health and social care needs. Discussion with staff suggested the needs were identified and were being met, even though there was a lack of written changes to the plan. Staff indicated they were reluctant to write on the computer printed plans of care and would rely on good verbal communication systems until the formal monthly review of the plan took place. Residents are at risk if these informal systems of communication break down. The storage of empty oxygen cylinders behind a sofa in an upstairs hallway was observed. This is unsafe and puts residents and staff at risk should they get knocked over.
Kingswood House Version 1.10 Page 10 The practice of senior carers taking and recording the residents pulse rate prior to administration of a specific medicine was discussed. This was seen in the resident’s records and had been raised as a requirement at the previous inspection. Residents are at risk if the senior carer has not been taught and assessed by a Registered Nurse to ensure they are taking and recording the pulse accurately and know when to refer to a health care professional before giving the medicine. The Manager reported that the District Nurse was booked to provide training supervision and assessment of senior care assistants. A number of residents and family members were spoken to and everyone who commented on the staff said they felt the staff treated them with respect and respected their privacy. Staff were seen knocking on doors prior to entering. Information in the resident’s files clearly identified their wishes and their family’s wishes at the time of the resident’s death had been explored. Kingswood House Version 1.10 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) 12.13.14.15 Resident’s daily life and social needs are well catered for, promoting a wide variety of daily activities for people living in the home. Residents receive a well balanced, well presented choice of meals. EVIDENCE: 12 Residents were spoken to during the inspection and they provided many examples of activities they had been involved in, for example, the residents meetings, trips to shows, boat trips, and attending the local church. The home also has an annual barbeque, coffee mornings and a wide range of in-house entertainment, which are displayed on the notice board. There are plans to introduce a newsletter for the residents and their families. One resident said she did not always want to join in, and the staff respected this. A number of residents were spoken to during the evening meal and those who commented on the food said it was good, plentiful and they were given choices to meet their individual needs. The home has recently achieved the Heartbeat award for offering a healthy option menu. Kingswood House Version 1.10 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) 17 Arrangements for enabling residents to exercise their legal rights are satisfactory allowing them to exercise judgements and choice in the civic process. EVIDENCE: Residents spoken to indicated they had taken part in the current election process and that both they and their families had been consulted fully by the Manager to enable this to happen. Kingswood House Version 1.10 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) 19.20.22.24.25.26. The overall quality of the furnishings and décor of the home is good, providing a comfortable, clean and pleasant environment both inside and outside. EVIDENCE: The home has an ongoing redecoration programme with a plan for one resident room to be redecorated every month. The residents said they were involved in the choice of décor. There is a handy man available to carry out a range of ongoing minor repairs that are requested in a book in the home. The home has two hoists to help with moving any resident who is assessed as needing assistance. There is an attractive dinning room that contains small tables enabling residents to sit in small groups. There are two lounges, one of which over looks the garden, which is attractive and well maintained. Two residents rooms were visited and they were found to be clean and comfortable, and contained many of the resident’s personal possessions making them more familiar and homely. Areas of the home that were visited were clean and welcoming. Kingswood House Version 1.10 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) 27.28.29.30. There are minor shortfalls in the home’s recruitment practices, which could put the interviewer at risk. The staffing levels and competence of the staff is good and as a result residents receive consistent care. EVIDENCE: There is a low turn over of staff in the home and staffing numbers recorded on the rota, are sufficient for the level of dependency of the residents. A mealtime was observed and all residents received their food promptly and those requiring assistance were able to receive it. Over 50 of staff in the home now has an NVQ`level 2 or above qualification and some other staff are commencing NVQ`soon. The statement of purpose clearly identifies individual staff and their qualifications, and copies of certificates are available for residents and families to see. The current interview process is carried out by two members of staff. An interview scoring assessment has been developed to be completed by the interviewer. No staff has been recruited since the last inspection. Application forms are completed. Kingswood House Version 1.10 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) 31.32.33.35.38. The manager and deputy manager provide effective leadership within the home that promotes staff involvement and easy access to the senior management team for residents, families and staff. This results in effective communication and consistent standards of care. There are minor shortfalls in the provision of a safe environment that could put staff and residents at risk. EVIDENCE: The Deputy Manager has recently completed NVQ`level 4 in management and care and the Manager is in the process of completing the same. The staff, residents and visitors spoken to during the inspection said the Manager and Deputy Manager were approachable, and dealt with issues promptly. The results of a recent residents survey (April 2005) showed a high level of satisfaction with the provision within the home. The results will be published in the newsletter for the home. Any issues raised as cause for concern will be discussed at the residents meeting. Secure facilities are available for the safe keeping of resident’s money, and there is a robust system for maintaining written records of any transactions. Two empty oxygen cylinders were found behind a sofa on the first floor. There was no evidence of a risk assessment
Kingswood House Version 1.10 Page 16 having been carried out regarding the use or storage of oxygen cylinders. There were no secure storage facilities to prevent the cylinders from falling over and no safe system for moving the cylinders when in use by a resident. Kingswood House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 x 3 3 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 Standard No 16 17 18 Score x 3 x 3 3 3 x 3 x x 2 Kingswood House Version 1.10 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. Standard OP7 Regulation 15(2) b Requirement Residents documented risk assessments and care plans must be kept up to date and reflect the current needs of the resident, to enable appropriate care to be delivered A risk assessment regarding the storage and movement of cylinders in use in the home must be carried out and advice sought and implemented regarding appropriate secure storage facilities. Timescale for action 30.6.05 2. 3. OP8OP38 13(2 (4)a 30.6.05 4. 5. 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 Information for families and residents regarding the provision of staff escorts for residents to attend emergency or booked hospital appointments should be included in the service users guide.
Version 1.10 Page 19 Kingswood House Kingswood House Version 1.10 Page 20 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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