CARE HOMES FOR OLDER PEOPLE
Kington St Michael Residential Home 81 Kington St Michael Chippenham Wiltshire SN14 6JB Lead Inspector
Elaine Barber Unannounced 2 August 2005
nd 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. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Kington St Michael Address 81 Kington St Michael Chippenham Wiltshire SN14 6JB 0149 750737 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) Mr Jitendra Kumar Singh Tirbhowan Mrs Sashtee Teelucksingh-Tirbhowan Care Home 9 Category(ies) of DE Dementia (1) registration, with number DE(E) Dementia - over 65 (8) of places OP Old Age (8) Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 One named male service under the category DE, until 15th April 2007 Date of last inspection 22 March 2005 Brief Description of the Service: The home is situated in the village of Kington St Michael in a large building, parts of which date back to 1660. The home is registered for older people and older people who have had a diagnosis of dementia. The home is adjacent to the pub and the village provides many amenities. The home is owned and run by independent providers, Mr and Mrs Tirbhowan. During the waking day there is a minimum of two staff who are involved in cooking and cleaning as well as care. There is a member of staff sleeping in. There is a set of steps from the pavement to the front door although there is level access to the rear of the property. All the bedrooms are single accommodation and have en-suite facilities save one which has its own nearby private toilet. On the ground floor there is a large sitting room, separate dining room, kitchen, toilet, laundry facilities, one of the bedrooms and an office. The first floor is accessed by two sets of stairs, one with a stairlift. To the rear of the home there is a garden with a large level patio. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection and preparation took seven hours. The inspector talked to seven people living in the home, four members of staff and the manager, read records, including personal notes and medication records, and looked at the accommodation. What the service does well: What has improved since the last inspection?
The statement of purpose and service user guide had been amended to include room sizes and contained more detailed information to enable people to make an informed decision about moving into the home. Assessment information
Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 6 now included people’s social interests, their hobbies and their religious and cultural needs to ensure these needs were met. People had been registered with a dentist and had appointments booked in September to assess their dental health. More accurate records of administration of medication were being kept to protect people from missing their medication. The manager had applied for a variation of registration, which had been granted, to reflect the needs of people living in the home. 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. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 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 Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 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, 6 Most of people’s individual needs and aspirations were assessed to ensure that their needs would be met except for their dental needs. EVIDENCE: Four files were seen. There were pre-admission assessments in the files and information was also available from care management assessments, family and healthcare professionals. There were details about specific diagnoses. The assessments provided the basis for the service user plans. Although both the owners are qualified nurses, any nursing care is provided by the district nursing services. Since a requirement was made at the last inspection the assessments now included interests and hobbies and religious and cultural needs. However, the assessments did not include dental needs. The home does not provide intermediate care. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 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 All people’s health, personal and social care needs were not set out in their individual plans to ensure that their needs would be met. However, people’s health care needs were being met. People were protected by the home’s policies and procedures for dealing with medication except when new prescriptions were introduced. People felt that they were treated with respect and their right to privacy was upheld. EVIDENCE: Each person had a care plan generated from the information gathered before admission. The format gave guidance to staff about an identified problem or need and an action plan for each area showing how the need was to be met. These included aims and goals but it was not clear whether these were the aims and goals of the person or what outcome the person wanted. The care plans did not include how needs relating to personal care, dental care, health care, optical care and chiropody were to be addressed or the outcomes people wished to achieve from living in the home. Preferred routines for personal care giving were identified. Specialist advice also formed part of the care plan. Each person had a risk assessment for a particular part of their care, for example, bathing, manual handling, special diet, falls and going out. The dates on the care plans indicated that they were reviewed once a month.
Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 10 However people did not sign their care plans and one person was not clear what a care plan was or whether they had one. A requirement from the last inspection to improve care plans had not been addressed. Records show that service users are registered with the local GP who usually visits them at the home. One person said that their GP visited them in the privacy of their room. Another commented that they go to the local surgery. People have access to other healthcare professionals, including an optician, a district nurse, community psychiatric nurse and chiropodist as needed. Pressure areas with treated by the district nurse and one person had been recently referred. Continence problems are investigated and referred to the nurse. The proprietors are registered mental health nurses and have the skills and experience to recognise changes in psychological health. Nutritional health is monitored including weight and dietary needs and preferences. Dental needs were not identified in the assessments or care plans however the staff reported and the notes showed, that people had been registered with a dentist and appointments had been made. There is a medication policy. The home uses a monitored dosage system, which is kept secure in a locked cupboard. No-one administered their own medication. There were records of medication received into the home, administered and returned to the pharmacist. No controlled medication was prescribed. The manager sought advice about medication from the pharmacist. The GP monitored people’s medication. The staff were undertaking training about medication with Swindon College. Some changes had been made to the printed administration records when new prescriptions had been issued. The changes were in hand writing and were not dated or signed and one change did not include the directions for taking the medication. Each person had a single room, which was individually furnished and their own ensuite or private toilet. People said that staff respected their privacy and personal care took place in the privacy of their room or the bathroom. One person said that the GP visited them in the privacy of their room. People had their own individual clothing. People’s preferred form of address was recorded in their notes and staff were calling them by the names that they preferred. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 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, 15 People found that the lifestyle in the home matched their expectations and preferences and satisfied their social, cultural, religious and recreational interests and needs. People maintained contact with their family and friends and local community as they wished. People had a wholesome appealing and balanced diet served in pleasant surroundings at times convenient to them. EVIDENCE: Each person’s choice of routine, leisure, social activities, cultural interests, personal and social relationships and religious observance were recorded in their individual plans. Each person had an individual routine and chose when to get up and go to bed, where to eat their meals and how to spend their time. Talking to people in the lounge it was apparent that people liked to sit in the lounge and chat or watch TV during the day. Staff go in and out of the lounge and talk to people for brief periods. The manager and staff reported that they take people out to the local shops and for walks or take people out in the car. They offer to take people out but often they don’t want to go. The manager had taken three people out the day before to visit someone who had recently moved out of the home. One person went out independently and one person liked to draw. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 12 The statement of purpose said that visitors could call at any time respecting meal times and bedtimes. Visits were recorded in the personal notes. Four people spoken to said that they had regularl visits from family and friends, and their relatives took them out. One person visited a relative. People were offered three full meals a day, breakfast, lunch and supper. Breakfast was flexible and people had this in their rooms. Lunch was around 12 noon and supper was at 5-30pm and drinks were served throughout the day. There was a further drink and snack at 8-30 pm. Two people also took sandwiches to their rooms in the evening. There was a fixed menu but staff and the people said that an alternative was offered if someone did not like the meal. At lunch one person had an alternative of fish cakes. The meal at lunch time was well presented and hot. People said that they enjoyed their meals and were observed enjoying their lunch. Special diets could be catered for. Two people had a diabetic diet and staff demonstrated an understanding of their dietary needs and controlling their blood sugar. The menu showed that a varied and balanced diet was being served. The dining room table was attractively laid and people had individual napkins. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 People were confident that their complaints would be listened to, taken seriously and acted upon. EVIDENCE: There was a complaints procedure, which stated how complaints would be dealt with and the timescales for responding to complaints. There was a process for recording complaints and investigations but there had been no complaints since the last inspection. Several people did not know about the complaints procedure. However they know how to complain to the manager or a member of staff and they were confident that they would sort out the problem. They had no complaints and were satisfied with the service. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24 People lived in a safe, well-maintained environment with access to comfortable indoor and outdoor communal facilities. They had their own toilets and washing facilities and there were sufficient bathroom facilities. People had the equipment they needed to maximise their independence. People lived in bedrooms which suited their needs and which were comfortable. People had their own things around them and they liked their rooms. EVIDENCE: The home is decorated and maintained to a good standard. Access is via a flight of steps from the pavement. The owners make it clear to prospective service users that the building is not always accessible to people who may have mobility problems although some aids are provided. People have access to all the communal areas. There is a stair lift and there is bath seat installed in the bathroom. All of the bedrooms and communal areas have a call alarm. There were grab rails in the toilets.
Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 15 There are no outstanding requirements from the environmental health officer’s or the fire officer’s last inspections. There was a record of maintenance. The garden was accessible to service users. There was no CCTV. The home has a large homely sitting room and a separate dining room. These rooms were well lit with natural light and furnished with good quality furniture and fittings. People sitting in the lounge said that the lounge was very comfortable. There is 5.3m² of communal space per person. There was no communal space to receive visitors in private. However people could receive visitors in the office, which provided comfortable seating. There is a house rule of no smoking indoors and one person smoked outside. This rule was made clear to them before they moved in. The garden to the rear of the property is spacious with a large paved area and people sometimes sit outside in the summer. All of the bedrooms except one had its own en-suite facilities. This bedroom had its own private toilet. There are two toilets and a separate bathroom with a bath seat. All of the bedrooms were single. Three of the rooms exceed 10 square meters of usable floor space and six exceed 12 square meters. Many people had brought items of furniture and possessions to personalise their rooms. The bedrooms were warm and comfortable with good quality furniture and bedding. All of the rooms had curtains, mirrors, over-head and bedside lights and were carpeted. People said that they liked their rooms. No-one had a key to their bedroom. There were entries in the care notes to show that people were consulted and chose not to have a lock. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 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 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 People’s needs were being met by sufficient staff with an appropriate mix of skills. People were protected by the home’s recruitment policies and practices. People were supported by staff who were trained and competent to do their jobs. EVIDENCE: There were two staff on duty at all times of the day. The owners or a member of their family carry out the sleep in duties. There are no waking night staff and none of the staff are under eighteen. Staff have a multi-purpose role and do cooking and cleaning as well as care tasks. One person said that the staff are friendly and helpful and provide as much help as they needed. Another said that the staff are friendly and have ‘hearts of gold’. There had been no new staff recruited since the last time the standard about recruitment was inspected and met. Four staff have National Vocational Qualification Level 2, one has NVQ Level 3 and the two proprietors have nursing qualifications so the workforce training targets had been exceeded. All the staff were undertaking training about medication from Swindon College. Staff had also done manual handling refresher training. The manager and staff reported that training about dementia was planned. The manager also said that she planned first aid refresher training for staff after that.
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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) These standards were not assessed. EVIDENCE: Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 19 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 4 3 4 3 x x STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 20 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. Standard 3 7 & 12 Regulation 14-1a 16-2 m & n 15-1 & 2a 16-2 m & n Requirement Timescale for action 31st October 2005 31st October 2005 3. 9 13-2 Assessments must include all health care needs including dental care. Care plans must include the action to be taken to address all aspects of personal, social and healthcare needs as set out in Standard 3, including dental care, social interests, hobbies, leisure activities and religious and cultural needs. People must be involved in developing their care plans, sign their plan and be given a copy. Outstanding from 22nd March 2005. When a new presription is issued 2-8-05 a record must be made on the administration sheet which is dated and signed. The directions from the GP for taking the medication must be included in the record. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 21 Kington St Michael Residential Home 1. 2. 3. Standard 7 8 16 It would be good practice for care plans to include the outcomes which individual people wish to achieve from living in the home. All visits to health care professionals should be recorded in the personal notes. Each service user should be made aware of the complaints procedure and how to make a complaint. Kington St Michael Residential Home D51_D01_S28153_KINGTONStMICHAEL_v244271_20705_Stage4.doc Version 1.40 Page 22 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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