Inspection on 23/05/06 for Kite Hill Nursing Home

This inspection was carried out on 23rd May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kite Hill Nursing Home 12/01/06

Kite Hill Nursing Home 06/06/05

Kite Hill Nursing Home 19/01/05

Kite Hill Nursing Home 07/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Kite Hill Nursing Home Kite Hill Wootton Bridge Isle Of Wight PO33 4LE Lead Inspector Janet Ktomi Unannounced Inspection 23rd May 2006 10:00 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 Kite Hill Nursing Home DS0000012562.V289164.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. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kite Hill Nursing Home Address Kite Hill Wootton Bridge Isle Of Wight PO33 4LE 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) 01983 882874 01983 883059 Colville Care Limited Margaret Groves Care Home 31 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (31), of places Physical disability over 65 years of age (10), Terminally ill over 65 years of age (5) Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is also registered for two places for people under 65 years of age, within the categories of TI, PD and DE 12th January 2006 Date of last inspection Brief Description of the Service: Kite Hill Nursing Home is situated on the main Newport to Ryde road and can be located fractionally beyond Wootton Bridge, as you head from Wootton to Ryde. Access to the home can be achieved via public transport, the local bus company running a scheduled service that passes the home or private transportation, with car parking available to both the front and side aspects of the home. The premises is a large period property that has been extended and adapted to provide residential accommodation across two floors, all floors accessible via a combination of passenger lift and platform lift, ensuring all rooms are accessible to service users and visitors. The accommodation provided at Kite Hill is exclusively single occupancy, a large proportion of the rooms containing open plan en-suite facilities that are screened off from the rooms via curtains/screening. An extension to provide a large lounge/dining room and improved management, maintenance and storage areas will be completed July/August 2006. The home is owned by Colville Care Limited and managed by the matron, Mrs Margaret Groves. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 23rd May 2006. The inspector would like to thank the people who live at the home, visitors and the staff for their full assistance and co-operation with the unannounced site visit. The site visit was undertaken by one inspector and lasted approximately seven hours, commencing at 10.00 in the morning and being completed at 5.00 p.m. All core standards and a number of additional standards were assessed and compliance with requirements made at the previous inspection in January 2006 was assessed. The inspector was able to spend time with many of the staff employed in the home and was given free access to all areas, records and documentation required. A pre-inspection questionnaire was sent to the home and returned prior to the visit to the home. Service user and relative questionnaires were sent to the home with the pre-inspection questionnaire. These were distributed to service users and left for relatives to complete. Two relatives and four service user questionnaires were returned. Questionnaires were sent to care managers and GPs identified as providing a service to people living at the home. Two GPs and two care managers had responded at the time of writing this report. The inspector was able to meet one care manager during the visit to the home. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home and monthly reports from the owners. What the service does well: Relatives and service users were very happy with the service received at the home. Statements being ‘find it very difficult to find anything detrimental. Staff are more friends to residents than carers’. ‘Marvellous care, wonderful girls’. The proprietor is investing in the home with the extensions to two bedrooms and the new lounge/dining room. Further improvements to the private facilities for service users are planned. The matron confirmed that the owners are happy to provide equipment required by service users. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There was a requirement made following the previous inspection in January 2006 that staff must be provided with adult protection training. The matron confirmed that this had occurred however training records could not clearly identify this and discussions with staff indicated that they remained unclear about the actions they should take should there be an allegation of abuse. The qualified nurse on duty could not readily identify the adult protection policy and procedure. Staff must be aware of the action they should take should they Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 7 suspect abuse may have occurred. Additional training and consideration of an easy access, quick guide as to what to do should be available for qualified nurses who are in charge of the home. Training records are held individually for each staff member with staff (nursing and care) being expected to maintain their own records. These were viewed during the inspection and indicated that staff receive little training. The matron does not hold a central register of training undertaken and could not clearly identify when mandatory and specific training has been undertaken or is due. Discussions with the provider indicated that the company has a training coordinator, however this person has been heavily involved in the extension project and work at the provider’s other home. The provider acknowledged that training may have lapsed during this time. The matron must ensure that all staff undertake mandatory training and updates as well as training specific to the needs of the people who live at the home. The matron or training coordinator must maintain records of all training. The matron is required to submit to the Commission a training schedule for 2006/7 which identifies that all staff will receive appropriate mandatory and specific training required to enable them to appropriately care for the people who live at the home. Staff supervision records are held with individual training records. These folders are stored in a filing cabinet in the matron’s office, it would be possible for staff to read other people’s supervision records whilst accessing their own training or supervision records. These indicated that staff do not receive regular (at least six times per year) supervision. The matron must ensure that all staff receive formal supervision at least six times per year, this must be recorded and stored where other staff are unable to access supervision records. 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. Kite Hill Nursing Home DS0000012562.V289164.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 Kite Hill Nursing Home DS0000012562.V289164.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home’s brochure and information about fees (including entitlement to reimbursement of assessed nursing care fees) is available to all prospective service users or their relatives. All service users receive a contract/terms and conditions of residency. All service users are assessed prior to moving into the home either by the matron, senior nurse or in the case of the three NHS funded beds, by the hospital team responsible for the placement. Service users, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard six is not applicable as intermediate care is not provided at Kite Hill Nursing Home. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 10 EVIDENCE: Within the waiting area, adjacent to the front door and matron’s office, is a table containing all the information relating to the home and the services offered. This information includes copies of the combined statement of purpose and service users’ guide, leaflet (brochure) about the home, sample contract/terms of residency, copies of previous inspection reports, and back copies of the in house newsletter containing useful information about activities, changes in the home and staffing. Also available were leaflets about service users’ rights to reclaim the nursing care element of their fees from the NHS. The home maintains a referrals file that was seen to contain appropriate information about people who had enquired about the service. The diagnosis and health information about the referrals would seem to indicate that the home would be able to meet their needs. Comment cards were received from four service users prior to the visit. These all stated that the service users felt well cared for and had received a contract (or their solicitor had). At the time of the unannounced visit to the home the relatives of a potential service user were visiting the home with a view to their father being admitted when a vacancy was available. The matron was overheard asking relevant questions to determine if this might be an appropriate referral and that the home could meet the health and social care needs of their relative. The relatives were shown around the home. Information was given to the relatives about the admission procedure and advice about fees (to contact the care manager) and that a full assessment would have to be undertaken at the nursing home the service user was currently living in under an intermediate care arrangement with the NHS. The matron also advised that, if possible, the potential service user might be happier if he could transfer within his existing nursing home to a non-intermediate care room. Discussions with the matron indicated that she was clear about the range of nursing needs the home could accommodate and that she would not admit people if the home did not have the necessary equipment to meet their needs. The matron stated that the providers will ensure that the correct equipment is available and had recently purchased a nebuliser machine for one service user. With service user files were copies of the individual pre-admission assessments completed by the matron. These identified that the home would be able to meet the person’s needs. These covered all the required areas of assessment and information was seen to be transferred to care plans. The matron explained that due to the level of disability it is more likely that the relatives or representatives of a service user will visit the home than the service user, although the home would support visits from potential service users were this possible. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 11 The home has three beds that are funded by the NHS. The admission arrangements for these beds are different to that for the traditional nursing care beds in the home. Pre-admission assessments are undertaken by nurses from the NHS team responsible for the beds. These are faxed or delivered to the home. The matron stated that the information provided is usually appropriate but that she is able to clarify information with the NHS team when necessary. The inspector met with two of the three people staying in the NHS short term beds. These service users confirmed they were happy with the care provided at the home, however they had not been provided with a choice about the placement. This issue of choice in the NHS funded beds is not one the home can influence directly, as their contract is with the hospital not the individuals receiving a service. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. All service users have individual care plans stored in their bedrooms and available for use by all staff caring for the person. Services users’ health needs would appear to be met. Medication was found to be stored, administered and recorded appropriately. Service users feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Unfortunately many of the people living at Kite Hill were unable to effect communication with the inspector due to a combination of their frail condition or diagnosis. However the inspector was able to speak with two long term service users and two people staying in the NHS funded beds. All stated that they were happy living at the home, that the staff were pleasant and helpful, they felt they were being well looked after and that they would recommend the home to relatives in need of such a service. Other service users were met during the inspection and appeared comfortable and appropriately care for. The inspector was able to speak with some relatives and visitors. All were Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 13 complimentary of the care provided to their relatives. One stated that whilst her relative had been in hospital for a prolonged period of time she had felt it necessary to visit every day to ensure that he was fully cared for. Since his move to Kite Hill Nursing Home she continues to visit frequently but had recently had a weekend off from visiting as she was confident that the nurses and carers would ensure his needs were fully met and contact her if there was any change in his condition. Other relatives were equally confident that their relatives’ care needs would be fully met and stated that they are kept aware of any changes in health needs. Health needs were seen to be identified on the pre-admission assessments with relevant information transferred to care plans. Individual service users’ files seen in the office would indicate that health care needs are met. At the time of the unannounced visit to the home a care manager was also visiting the home to conduct a review of the placement for one of her clients. The care manager stated that she felt her client was much improved and that his health and social needs were being met at the home. All bedrooms are for single occupancy, with most equipped with en-suite facilities. The home has undertaken a small extension to one side of the home to provide en-suite facilities to two bedrooms and plans to convert a small bedroom to an en-suite facility for the adjacent bedroom. Individual rooms ensure that service user privacy and dignity are respected and maintained during personal care. Service users and relatives spoken with during the visit confirmed that privacy and dignity are maintained for all service users and that staff respect their choices about how and when care is provided. Many service users are very frail and subsequently cared for in bed, those seen were noted to appear comfortable and appropriately clothed. There were no unpleasant odours noted in the home. Two relative comment cards were returned prior to the inspection. These stated that they were both satisfied with the overall care provided and they were kept informed of important matters affecting their relative. Two GPs returned comment cards, all their responses were positive, they were satisfied with the overall care provided to service users, specific advice is incorporated into care plans and there was always a senior member of staff available to confer with. Comment cards were also received from service users. These stated that service users felt they were well cared for ‘very good care’, ‘wonderful care – marvellous girls’, and confirmed that they felt they always received the care and support they need. Service users’ comment cards also stated that they felt they always received the medical support they needed. The matron explained that she is able to directly refer service users to external health professionals such as physios, dieticians and occupational therapists via her contacts with the NHS team who fund three beds within the home. The matron stated that she can arrange a visiting optician, a chiropodist visits regularly (included in invoices seen for additional services), however dentists Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 14 could be harder to arrange. If service users are able to fund private dental care this can be arranged, otherwise referrals have to be requested via the GP to the NHS clinic in Carisbrook. Whilst touring the home it was noted that all beds are electric profiling beds of a pleasant wooden design that do not appear institutional. Service users stated that the beds were comfortable. Pressure relieving mattresses were also seen within a number of bedrooms with the matron clear that she would not admit someone unless she had the necessary equipment to meet their needs. All medication is administered by qualified nurses. The medication administration records (MAR sheets) were viewed and found to be fully completed. NHS prescription sheets are used for the three NHS funded beds, these were also found to be fully completed. Medication is individually stored in a suitable lockable facility within each bedroom with stock and cool medication kept in the treatment room adjacent to the manager’s office. The fridge was found to be locked and daily temperature recordings maintained. The inspector observed the nurse administering medications that are dispensed from the secure storage cupboard in each bedroom to the service user and the MAR sheets then signed to confirm administration. As with all nursing homes the home is no longer able to return unused medication to the dispensing pharmacy. The home has recently contracted with an approved disposal firm and the containers for disposal were seen. The matron explained that she intends to alter some of the cupboards within her office to enable the large disposal bin to be secured in a locked cupboard. The manager confirmed that appropriate records of disposal would be maintained for general and controlled medications. Comment cards from GPs indicated that they felt that medication was appropriately managed within the home. Kite Hill Nursing Home DS0000012562.V289164.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Service users find the lifestyle experienced in the home matches their expectations and preferences. Service users are able to maintain contact with family and friends. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome nutritious diet. EVIDENCE: As previously stated the provider is currently investing in the communal areas of the home with the building of a large lounge/dining room as part of an extension which will greatly improve the home’s facilities without increasing the number of bedrooms and service users catered for. Once completed, in July or August 2006, this will provide a pleasant, bright airy room with views from the balcony down to the river. The room will be large enough to accommodate both lounge and dining room furniture. At the time of the site visit the inspector was shown the room, which is now ready for internal decoration and electrics etc. to be connected. There is level access to the extension and a large WC will also be provided as part of the extension. Discussions with care staff indicated that they are keen to encourage service users to use the lounge/dining room once completed and they felt it will be a Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 16 valuable communal space. During this site visit the existing lounge was viewed, this is much smaller than the new extension will provide and was seen to contain stored equipment providing limited space for service users. The home does not at present have a dining room with all meals being taken in the service users’ bedrooms or for a few in the lounge. Four service users returned comment cards to the Commission prior to the inspection. Two stated that appropriate activities were always provided with the other two clearly being aware that activities were available but stating that they did not wish to participate, ‘I decline’, ‘I don’t wish to be involved’. The newsletter seen in the waiting area and distributed to all service users contained information about activities. The home has contracted with Independent Arts to provide art and craft activities on a Monday and music on a Friday afternoon. A video is provided on a Wednesday afternoon. Whilst touring the home evidence of completed art projects undertaken were seen in service users’ bedrooms. The home provides care for people with nursing needs and as such many are very frail with poor health and unable to participate in organised activities in a group setting. The matron explained that 1-1 activities are more popular, such as manicures. One service user has two pet budgies with staff supporting their care. Information about service users’ interests and hobbies is included as part of the pre-admission assessment. Information about which TV programmes one service user likes were seen listed on his bedroom wall. Comment cards were received from two relatives that stated that they were able to visit their relative in private and were kept informed about important matters affecting their relative. During the site visit a number of visitors were seen arriving at the home throughout the day. Visitors are requested to sign a visitors’ book on arrival and departure and most were seen to do so. Visitors spoken with confirmed that they were able to visit at all reasonable times and that refreshments were provided. The home does not have a private meeting room therefore most visitors see their relatives in the service user’s bedroom. The planned extension does not include a private meeting room for service users however the improved administration and office space could be used for professional meetings if required. The home has a telephone that can be taken to service users’ bedrooms to make or receive telephone calls in private. Details of the home’s visiting policy are available in the statement of purpose/service users’ guide that was seen in the main lobby. Four service users’ comment cards were returned prior to the visit. These all stated that staff always listen and act on what the service users say. This indicates that service users are helped to exercise choice and control over their lives. Many of the people who live at the home are very frail, care staff appeared to consider their needs and wishes with relatives stating that where service users are unable to make decisions for themselves their relatives are consulted and kept informed. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 17 Comment cards received from service users confirmed that they were happy with the food provided at the home, one stated ‘I don’t like fruit crumble, kitchen aware’, another that the food was ‘wonderful’. Those spoken with during the inspection were also very positive about the meals, stating that choice is available and the kitchen will provide alternatives if requested. Relatives spoken with also confirmed that the food looked appetising and that their relative liked the food. The inspector observed the lunchtime meals being served in the kitchen. Care staff inform the cook whose meal they are collecting and this is then served up and staff take it to the service user. The cook confirmed that she is provided with information about special diets and individual likes and dislikes. Meals served appeared pleasant and smelt tasty. Menus were supplied with the pre-inspection questionnaire returned by the matron prior to the site visit. These indicated that a varied diet is provided to service users with a variety of main meals and puddings. In the evening a hot option and soup along with a dessert is provided. Some service users are unable to enjoy the meals provided as they must be fed via a PEG system. Nursing staff confirmed that they have received training in the use of PEG feeds with some senior care staff also receiving training to understand PEG systems. Food and fluid charts were seen in some bedrooms indicating that service users who require assistance to take fluids are provided with the support and encouragement they require. Kite Hill Nursing Home DS0000012562.V289164.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 inspected at least once during a 12 month period. 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 the available evidence including a visit to this service. Service users and relatives are provided with information about the home’s complaints procedure. The home generally protects service users from abuse however care and nursing staff were unclear about the action they should take if an allegation of abuse were made. The matron is required to ensure staff have a quick access adult protection procedure and are aware of the action they should take if they suspect abuse may have occurred. EVIDENCE: The home provides service users with information as to how to make a complaint within the service users’ information. The home’s complaints policy and procedure fully complies with the requirements of the Care Homes Regulations 2001. Information as to how to complain via the Commission for Social Care Inspection is included in the service users’ information. Discussions with service users and visitors indicated that they felt able to complain and indicated that they would do so to either the manager or administrator. Care and nursing staff spoken with during the inspection were aware of what they should do if a service user or relative wished to complain. At the time of the unannounced inspection no service users or their visitors had any complaints or concerns to report to the inspector. Comment cards received from service Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 19 users stated that they all knew who to speak to should they be unhappy or wish to complain, however they also stated that they had no complaints. Comments added to the question asking do you know how to complain being ‘yes but don’t need to’. Many service users would need to rely on their relatives to complain on their behalf due to the level of their frailty and disability. Relatives spoken with during the visit stated they would talk to the matron or owner (who is often at the home supervising the extension work) but had no complaints at the time of the visit. Comment cards from relatives indicated that one was aware of the home’s complaints procedure and one not. Neither had any concerns to add to the comment cards. Following the previous inspection in January 2006 the home was required to ensure all staff had training in adult protection. The matron stated that this had occurred however the home’s system for recording training did not evidence this. Discussions with nursing and care staff indicated that they were unclear about the action they should take should a service user report that they had been abused. Nursing staff could not readily identify the adult protection policy and procedure although he matron found this immediately. The matron must ensure that all staff are aware of the action they should take if they suspect abuse may have occurred. A quick access procedure clearly states what they should do and who they must contact must be available. As with other training undertaken at the home the matron must ensure that she can evidence that adult protection training has occurred and the content of the training provided. Also following the previous inspection in January 2006 the home was required to ensure that all the appropriate information and checks are completed prior to commencing a staff member’s employment. Staff files were viewed and all the required checks are now being undertaken. This requirement has been met. The home does not become involved in service users’ personal finances, these are handled by relatives or representatives. The home invoices the person responsible for the service user’s finances each month and provides an itemised bill for all additional services such as chiropody, newspapers or toiletries. A sample of these was seen on the administrator’s computer. Kite Hill Nursing Home DS0000012562.V289164.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 at least once during a 12 month period. 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 the available evidence including a visit to this service. The home’s environment is safe and suitable for the people who live at the home. The home was found to be clean and free from offensive odours. An extension providing improved communal areas is nearing completion with an additional smaller extension also almost completed to enlarge two ground floor bedrooms and provide them with en-suite facilities. EVIDENCE: The inspector had not previously visited the home as part of a key inspection so had an initial tour of the building with the matron and viewed the new extension with the proprietor. The inspector was then able to move freely around the home whilst talking to visitors and service users. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 21 The premises consists of an older building with an extension providing additional bedrooms to the rear of the home. As previously mentioned there is currently more building work at the home to provide a large lounge/dining room, administration and maintenance offices, storage areas and also some extensions to two small bedrooms. These should be completed in July/August 2006. The owner also plans some internal work on the older part of the home converting the existing lounge to a bedroom with en-suite facilities and changing a small bedroom to provide an en-suite for the adjacent room. At the time of the visit the gardens were unusable due to construction work but will be restored to provide car parking to the rear of the home and pleasant garden areas which will be accessible to service users. All bedrooms within the home are for single occupation, many equipped with en-suite facilities. All bedrooms are equipped with modern adjustable height beds that have a wood effect finish, so reducing the clinical appearance. The home has shaft and platform lifts making all areas of the home accessible to all service users. The home employs a maintenance person with whom the inspector was able to talk during the site visit. He explained his role and stated that he was looking forward to having a maintenance office and storage areas provided within the basement of the new extension. Service users and visitors raised no concerns regarding their personal accommodation, many people having brought personal items into the home. The home was found to be clean, tidy and free from offensive odours. Staff have access to appropriate protective clothing and equipment and arrangements for the prevention of cross infection appear appropriate. Kite Hill Nursing Home DS0000012562.V289164.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 at least once during a 12 month period. 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 the available evidence including a visit to this service. The home provides appropriate numbers of staff to meet service users’ needs. New staff do receive all the required pre-employment checks and an appropriate induction. The matron is required to provide the Commission with a training programme for 2006/7 to confirm that all staff receive the required mandatory and specific training necessary for them to undertake their roles. The home must maintain a record of all training undertaken by nursing and care staff. EVIDENCE: The matron supplies copies of duty rotas with the pre-inspection information prior to the site visit. Also recorded in the pre-inspection questionnaire was that the home has increased the staffing levels during the afternoon and now provides an additional carer during this time (2 – 8 p.m.). These show that the home aims to provide one qualified and six additional staff (qualified or care) in the mornings, one qualified and four additional in the afternoon and one qualified and two additional at night. These numbers were confirmed during the inspection and corresponded to nursing and care staff on duty at the time of the site visit. Service users and relatives confirmed to the inspector that there were enough staff on duty to support them and call bells were answered promptly. Care staff stated that they felt there were enough staff to enable them to meet service users’ needs. Responses received from relatives and Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 23 service users in comment cards were positive about the home’s staff including ‘marvellous girls, couldn’t be nicer’, ‘always give you time’. Responses from GPs stated that there was always a senior member of staff to confer with. Care managers’ comment cards also stated that there was a senior member of staff available to speak with them. Relatives’ comment cards confirmed that they felt there were sufficient numbers of staff on duty. During the inspection staff were seen to have time to care for service users and call bells were promptly responded to. In addition to care staff employed the home employs a full team of ancillary staff including chefs, kitchen assistants, cleaners, administration and maintenance/gardener. Care and nursing staff stated that wherever possible they will cover additional shifts resulting from annual leave or sickness so that agency staff are rarely used. The home has reviewed the booking arrangements for agency staff following a booking problem when an auxiliary nurse was supplied by an agency and not the qualified nurse the home required, this resulted in the home not having a qualified nurse present of a night shift. The home has also produced a policy to ensure that the qualifications of agency staff will be checked by the nurse handing over responsibility for the home. The pre-inspection questionnaire completed by the matron stated that 65 of care staff have at least NVQ level 2. This is also indicated on the duty rotas supplied. Care staff spoken with confirmed they had NVQ level 2 which corresponded to the information relating to their names on the duty rota. Following the previous inspection in January 2006 the home was required to ensure that all pre-employment checks were undertaken, these related to references, documentation to confirm the applicant’s identity and photographic identification. Staff files were checked during this site visit and were found to contain all the required documentation and information. This requirement has therefore been met. The inspector discussed the home’s induction procedure with the matron who stated that new staff are initially supernumerary for the first four shifts, possibly more depending on previous experience and qualifications. During this time they have one day in the office and then undertake shadow shifts. No new staff were on duty during the site visit so the inspector was unable to discuss their induction experience. The manager listed staff training undertaken and planned for the future on the pre-inspection questionnaire but did not include a detailed list of qualified and care staff training undertaken or planned. Other than fire instruction no mandatory training was listed. This was discussed with the matron who confirmed that she did not have accurate records available to confirm when staff last undertook mandatory training and when updates are due. Nursing and care staff maintain their own records of training undertaken. These records were viewed during the site visit. Records did not clearly evidence that all staff Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 24 are receiving all the mandatory training, some contained references to service user specific training (i.e. PEG feeds) staff had undertaken in the home. The inspector was able to talk with qualified and care staff. They stated that they did not have regular training in both mandatory and service user specific care. Discussions with the matron indicated that whereas previously she had been able to access training via the hospital this had been curtailed due to the financial pressures on the hospital budgets. The inspector was able to discuss her concerns about training with the proprietor who confirmed that the company employs a training co-ordinator, however this person had been heavily involved in the extension and with the company’s other home, and that he acknowledged that training at Kite Hill may have lapsed. The matron must supply to the Commission a training programme for qualified and care staff which must include all mandatory (infection control, fire awareness, moving and handling, health and safety, adult protection and, if appropriate, food hygiene) as well as training relevant to ensure that service users’ needs are met. The current system of staff recording training does not provide the necessary information therefore the matron (or training coordinator) must also maintain records of training undertaken that are available for inspection. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The manager is appropriately experienced to manage the home. The home undertakes internal quality assurance questionnaires, however the matron was unaware if these were formally analysed by the proprietors and does not receive feedback in the form of a report. The home does not become involved in service users’ personal finances. Staff do not receive regular (six times per year) supervision. The home is generally a safe place for service users, visitors and staff. EVIDENCE: The home is managed by a matron who is a skilled and competent manager. Matron is a registered nurse who has also gained the Registered Manager’s Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 26 Award. The matron confirmed that the proprietors allow her to manage the home effectively and accept her advice and recommendations in respect of equipment required for service users and the increase of staffing levels during the afternoon shift. The matron must ensure that her training needs and that undertaken are included in the training programme for the home. The proprietors are regularly at the home and showed the inspector round the new extension. He also discussed the future plans to improve other areas of the home. During the site visit the inspector was shown blank quality assurance questionnaires that the matron stated are provided to service users (or relatives) about twice per year. Short stay service users such as those using the NHS beds are also provided with questionnaires when they are due to go home. The matron stated that once completed these are sent to the administration office. The matron did not have a copy of a report detailing the outcomes of the surveys and was unsure if one was produced. Without a report the matron would be unable to determine if changes in the service provided were necessary or be able to justify additional expense etc. on staffing or equipment. Positive responses could also not be fed back to nursing and care staff. The home must ensure that a report is available stating the outcomes of quality assurance audits. A copy must be sent to the Commission. The home does not become involved in service users’ personal finances, these are handled by relatives or representatives. The home invoices the person responsible for the service user’s finances each month and provides an itemised bill for all additional services such as chiropody, newspapers or toiletries. A sample was seen on the administrator’s computer. Nursing and care staff stated that regular formal supervision does not occur at least six times per year. The matron stated that there are discussions about specific care and service user issues as part of handovers and at other times as required. The matron stated that when there are issues to discuss with individual staff this does occur. Supervision records are maintained by the individual staff member along with their training records. These were viewed and found to be incomplete and confirmed staff statements that supervision does not regularly occur. The storage of supervision records in a cabinet that all staff have access too is also unacceptable. The manager must implement a system to ensure that staff receive formal supervision at least six times per year and ensure that records of supervision are stored such that their confidentiality may be maintained. During the site visit a number of records were viewed. These were generally found to be well maintained and appropriately stored. As stated in the paragraphs above the matron must ensure that staff supervision records are securely stored and their confidentiality is ensured. The records in respect of Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 27 staff training were also found to be inadequate and the matron or training coordinator must ensure that accurate records of training undertaken are maintained. The quality audit report also represents an important record and this must be made available to the Commission, matron, staff, service users and visitors. During the site visit there were no indications that the home is not a safe place for service users, staff or visitors. The home must be able to show that staff have received all the necessary training to ensure they are aware of infection control, manual handling, fire awareness and health and safety. The new extension will provide improved facilities for the storage of items that may be hazardous to health. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 3 Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? no 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 OP18 Regulation 12 (1) (a) 18 (1) (a) Requirement The matron must ensure that all staff employed at the home are aware of the actions they must take if they suspect abuse of a service user may have occurred. Training records must detail adult protection training undertaken and the content of that training. The matron must supply to the Commission a training programme for 2006/7 showing that all mandatory and service user specific training is provided to all staff. The registered person must supply to the Commission a report of the review of the quality of care provided at the home. The matron, staff and service users/relatives must also have access to a copy of the report. The manager must implement a system to ensure that staff receive formal supervision at least six times per year and DS0000012562.V289164.R01.S.doc Timescale for action 01/08/06 2. OP18 12 (1)(a) 18 (1)(a) 01/08/06 3. OP30OP37 OP38 18 (1)(a) 01/08/06 4. OP33 OP37 24 (1), (2) and (3). 01/09/06 5. OP36 OP37 18 (2) 01/08/06 Kite Hill Nursing Home Version 5.2 Page 30 ensure that records of supervision are stored such that their confidentiality may be maintained. 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 OP18 Good Practice Recommendations Matron should produce a quick access adult protection procedure stating what action staff should follow in the event of their suspecting abuse may have occurred and numbers for agencies that must be contacted. Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Kite Hill Nursing Home DS0000012562.V289164.R01.S.doc Version 5.2 Page 32 - 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. 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