Inspection on 21/07/05 for Kitnocks House Nursing Home

This inspection was carried out on 21st July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Kitnocks House Nursing Home 25/07/08

Kitnocks House Nursing Home 24/07/07

Kitnocks House Nursing Home 22/11/06

Kitnocks House Nursing Home 13/01/06

Kitnocks House Nursing Home 18/01/05

Kitnocks House Nursing Home 07/07/04

Kitnocks House Nursing Home 08/01/04

Kitnocks House Nursing Home 22/07/03

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

CARE HOMES FOR OLDER PEOPLE Kitnocks House Nursing Home Wickham Road Curdridge Hampshire SO32 2HG Lead Inspector Val Sevier Unannounced 21/07/05 10.30am 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. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kitnocks House Nursing Home Address Wickham Road, Curdridge, Hampshire, SO32 2HG 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) 01489 798244 01489 799411 Kitnocks House Limited Mr Anthony Nicholas Murdoch CRH 49 Category(ies) of DE, DE(E), MD, MD(E) registration, with number of places Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Dispensation has been given to four named service users in the LD category to remain accommodated in the home. Date of last inspection 18/01/05 Brief Description of the Service: Kitnocks is a care home providing nursing and accommodation for 46 persons with mental health difficulties, from the age of 18 and is situated in the predominantly rural area of Curdridge, between the local villages of Botley, Wickham, and Bishops Waltham. The registered provider is Kitnocks Ltd. Kitnocks is a converted Edwardian building, originally refurbished and opened as a 32-bed nursing home in 1993. It was further extended in 1994, and now offers 49 beds for a number of client groups. In the main house there are 37 single rooms with 31 being ensuite and 6 double rooms with 4 with ensuite facilities. There is a passenger lift. The home is set in large grounds, “flexi paving” is provided so that the grounds may be accessed and enjoyed with minimal risks to service users. Seven of the 49 beds are in the extension and self-contained bungalow, which is attached to the main home. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 6 hours. The inspector was able to speak with several residents, staff and visitors to the home. A sample of residents assessments, care plans and medication were seen and a tour of the home undertaken. What the service does well: What has improved since the last inspection? The home has developed its understating of psychiatric illnesses and diagnosis with the development of training. The home has begun to recognise its strengths in terms of the areas of expertise and any needs for both staff and residents within those areas. These skills are supported for staff with regular clinical supervision and support from the manager and deputy. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 6 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. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5. Standard 6 is not applicable. The home has exceeded in its understanding of residents needs using the assessment process with support and advice sought as needed. The staff’s knowledge and understanding of residents support needs is very good. This was evident from positive relationships which have been formed between the staff and residents and supported by the training received. EVIDENCE: The inspector looked at 4 care plans and each individual had had an assessment prior to moving to the home. The assessments are comprehensive with information about physical and psychological needs of the individuals. It was observed that the information gained through the assessment had been used to complete the care plans. There was evidence of information from other professionals in this process and of support from the placement at which the person was placed at the time of assessment. This led to a thorough assessment and information being available to ensure that the home could meet the needs. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 9 A relative spoken with on the day, explained what had happened at the assessment for her relative and how she had been involved when the resident was unable to speak for them. The relative felt that the needs could be met. The inspector was able to observe interaction between the staff and residents at the home. The manager had explained that staff had undertaken training in more detail of mental health issues that were experienced by those in the home and communication and this was evident in the observed interaction. Staff spoken with had an understanding of the needs of individuals and said they felt able to ask the manager and deputy if they were unsure. The admissions policy and service users guide state that prospective residents and their relatives or representatives are encouraged to visit the home. Relatives spoken to on the day said that they had been welcomed on the visit to the home and had been able to speak with other relatives before making a decision. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 10 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 and 10. There has been a noticeable improvement in the care plans and the depth of information in them, with involvement of other professionals as needed. This is commended. Over the last two inspections it was seen there has been a big improvement in the management of medication. The staff were seen to interact well with residents identifying their emotional and physical needs, staff are commended in this. EVIDENCE: The inspector viewed four care plans in conjunction with a sample of medication records and others health-monitoring tools used at the home. When looking at the care plans it was seen that other professionals were also involved as necessary. Some individuals required continuing support from psychiatric services for example. The home is supported by a senior psychiatric practitioner twice a month and from a Dr who specialises in physical issues associated with head trauma, who also visit twice a month. It was noted that these two specialists also sits as needed and have supported the home in the pre admission process. These two people offer training when it is identified for particular needs. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 11 The care plans had clear identified needs and considerable depth in the action to be taken by staff to assist the residents. It also had the strengths and abilities of the individuals, which staff could then help to maintain. There were risk assessments and action to reduce risks. The care plans had been reviewed regularly and daily notes had been written enabling the inspector to have a picture of the daily life at the home for some. From written evidence of care plans and speaking with staff it would appear that the staff are equipped with knowledge and skills to care for the needs of people at the home. It would also seem speaking with staff and relatives that no one is afraid to ask questions about issues of concern about needs. It was seen in the care plans that physical health needs are also addressed with one resident having moved to the home with comprehensive information from a specialist unit this information has been incorporated into the care plan at this home. It was also seen that residents have access to opticians and dentists as needed. Relatives spoken with were involved in the care planning having meetings with the manger. They felt this was important, as the residents although involved, due to their personal issues are unable to give information or informed consent. It was also appreciated as the relatives spoken with had been the carers for in some cases years, and they felt that this kept them involved in the care. Medication its storage and administration was sampled on this occasion. There were no issues identified and there has been significant improvement in this area. Staff were observed speaking and assisting the residents with dignity and respect. Affection was given appropriately to those residents who sought it. It had been seen on care plans that the preferred choice of name had been recoded and staff were heard to speak to residents by the name they wished. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 12 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 and 14. The social needs of the residents at the home are as varied as they are individuals and it is possible not all needs are met. The home is encouraged to resolve this in order to accommodate as many needs as possible. EVIDENCE: The activities that are available at the home are arranged dependent on needs and individual interests. These interests were documented on the 4 care plans seen and enabled where possible. The home has employed ‘companions’ and sessional workers to offer individual time for some residents. A companion visits the home three times a week in the afternoon from 2 pm till 8pm when various activities are offered either group or individual. The monthly music group that it had been noted previously to which withdrawn residents responded well, has stopped at present. The manager has a written a paper praising its effects and use to this client group and it is hoped that it will restart in some form. There are links maintained with the community with visits to the home from ministers and the ex services mental welfare society. Also individuals attend community services such as Headway, The Causeway, the Hexagon Centre and a gardening club. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 13 There are no individuals at the home currently managing their own finances. However, staff were seen enabling residents maximise choice about their daily lives with regard to clothing, activities and meals. Some residents had bought personal belonging to their rooms to individualise them and happily explained their history and meaning to the inspector. It was observed that residents are enabled to be as autonomous as possible in their participation of events and express themselves through means open to them, verbally, through art, or movement. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 14 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 and 18 It would seem the staff in conjunction with the manager have worked at establishing a sense of openness at the home so that relatives and residents can voice their concerns. Staff also feel that they can voice concerns especially regarding the care of the residents. EVIDENCE: There have been no complaints made since the last inspection to either the home or to the CSCI. Relatives were aware of how to complain and said they felt comfortable in speaking with the manager or deputy about any issues. There has been one allegation regarding adult protection at the home since the last inspection, which has been resolved. The manager undertakes training the staff in this area, and staff spoken with were aware of the whistle blowing policy and the training. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 15 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 and 26. The home is well maintained and feels homely. EVIDENCE: The inspector undertook to walk around the home. There have been no changes with the exception of general maintenance of the home to ensure safety. It was seen to be clean and homely. The garden is landscaped with easy access to it for residents. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 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 and 30. The level of staff would seem to meet the needs of the residents. The training programme has led to an enthusiastic workforce that works positively with the residents to improve their quality of life. EVIDENCE: The staffing at the home would seem to meet the needs of the residents with two nurses on throughout the day with the addition of the deputy and or the manager with the addition of 10 care staff, this changes to 9 care staff in the pm. The home sometimes uses agency staff on per shift and arrangements have been made that the agency is aware of the staffing requirements of the home and faxes are sent to Kitnocks regarding the individual staff member, their training and confirming CRB checks have been undertaken. The evidence of training for staff was that thought and planning had been undertaken to ensure that staff had knowledge of the issues affecting the residents in their care, for example constraint/ restraint, the new mental capacity bill, appropriative feeding and unpredictable behaviours. The home has also given training to medical students on areas that the home specialises in such as Huntington’s. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 17 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 36 and 38. The manager is supported well by the senior staff in providing clear leadership throughout the home, with all staff demonstrating an awareness of their roles. There was evidence that health and safety is attended to protecting the well being of all at the home. EVIDENCE: The manager for the home is experienced and has undertaken appropriate courses to maintain both his professional registration and his skills in order to meet the needs of the residents and staff at the home. It would seem from talking with staff and relatives that the manager and team at the home have worked to establish openness at the home whereby staff and relatives can speak to the manager or deputy about any concerns they may have. This in turn has led to an opens to new ideas and the introduction of new people to the home such as student nurses, which gives a different perspective Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 18 to the service offered. The manager feels that the home has benefited from this openness combined with the established clinical supervision of staff. The fire maintenance file was seen and there were no concerns identified with appropriate checks and training having been carried out. Staff spoken with confirmed that they had undertaken training recently. Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 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 4 4 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 x 3 Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 20 No 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Kitnocks House Nursing Home H54 s12130 Kitnocks V232902 210705.doc Version 1.30 Page 21 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terace Southampton, Hants SO15 1GW 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. 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