Inspection on 22/11/06 for Kitnocks House Nursing Home

This inspection was carried out on 22nd November 2006.

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 13/01/06

Kitnocks House Nursing Home 21/07/05

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 Inspection 22nd November 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 Kitnocks House Nursing Home DS0000012130.V318152.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. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kitnocks House Nursing Home Address Wickham Road Curdridge Hampshire SO32 2HG 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) 01489 798244 01489 799411 kitnocks@zoom.co.uk Kitnocks House Limited Mr Anthony Nicholas Murdoch Care Home 49 Category(ies) of Dementia (49), Dementia - over 65 years of age registration, with number (49), Mental disorder, excluding learning of places disability or dementia (49), Mental Disorder, excluding learning disability or dementia - over 65 years of age (49) Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Dispensation has been given to 4 named service users in the LD category to remain accommodated in the home. 13th January 2006 Date of last inspection Brief Description of the Service: Kitnocks House (Kitnocks will be used throughout the report), is a care home providing nursing and accommodation for 49 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 House 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. The fees for the service are based on individually assessed needs and range from £548 to £1800. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: an unannounced visit to the home, which was carried out on the 22nd and 23rd of November 2006, during which there were discussions with staff, residents, relatives and visitors to the home. In addition 7 relatives had completed questionnaires prior to the visit. During the visit to the home a tour of the premises was carried out with where possible, permission of the residents at the home, this also included their rooms. Staff and care records were sampled and in addition to speaking with staff and residents, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. On this occasion the inspector was accompanied for part of the visit by an ‘expert by experience’ Tina Coldham, who spoke with some of the residents at the home about their experiences and who carried out a partial tour of the home. Tina’s observations and comments have been included in this report where she is referred to as expert by experience. Tina’s summary was “Whilst there were small things of a negative note, my impression that the home was well run and is a pleasant and caring environment.” What the service does well: The inspector was able to speak with two people who visit the home regularly and who undertake activities with the residents, the hairdresser and a community support worker; both have several years experience of the home and were positive about the service it provides. The support worker commented that “ I find the home warm and homely, a family feel”. Residents receive good support for a wide range of needs, which can be challenging both to them as individuals and to the staff. The staff are able to provide a good service because it is based on their knowledge, experience and Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 6 training. This is supported by the care plans and other written documentation, which have been agreed by the residents or relatives. Staff were seen to treat residents with respect and dignity and encourage risk taking as part of daily life activities. Residents and relatives both verbally and in comment cards were in agreement that the attitude and level of care was very good. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Kitnocks House Nursing Home DS0000012130.V318152.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 Kitnocks House Nursing Home DS0000012130.V318152.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (Standard 6 is not applicable to this service) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a very good understanding of residents needs with the assessment process they use that exceeds that of other comparable services. The admissions process is very good, providing prospective residents and their families with details and opportunities to enable them to make an informed decision about admission to the home. EVIDENCE: All care is taken in assessing prospective residents to fill any vacancies at the home as this ensures a well-balanced community. The staff are aware of the needs of service users and how their needs and aspirations can best be met. An information pack is given to individuals where an interest in the service has been received. It contains all the information necessary for an individual or Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 10 more often a relative, to make informed decisions as to whether the care offered at the service is for them. The inspector sampled five files and they all contained pre admission assessments. Information was also available from social services and health professionals as appropriate. One example included a plan for the placement to be reviewed at 4 weeks, 8 weeks and 12 weeks and a list of this to be included at the reviews, the service user, consultant, GP, relative/advocate, key worker and care manager. The first review had been undertaken and the report evidenced that these people had been involved and action taken. This was seen to be an active part of the assessment of individuals and to the care planning for them. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents receive very good support, in assisting with their daily life, care and leisure activities, which are based on their individual abilities and aspirations. The health needs of residents are well met with good multi disciplinary working taking place on a regular basis however, the systems for the administration of medication have declined since the last visit and potentially place residents at risk. EVIDENCE: The inspector sampled five care plans on this occasion in conjunction with a sample of medication records and other health-monitoring tools used at the home; she also spoke with several residents about their care programme. The care plans that have been developed for the residents were seen to be a working tool, with records of daily life and monthly evaluations by the key worker. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 12 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 doctor who specialises in physical issues associated with head trauma, who also visits twice a month. It was noted that these two specialists also visit as needed and have supported the home in the pre admission process. These two people offer training for staff when it has been identified it would be useful to meet an individual’s particular need. The care plans had clear identified needs and action to be taken 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 recent residents having moved to the home with comprehensive information from health and other specialists; 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 not always able to give information or informed consent. The consultation 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. The residents have a wide range of mental health issues which need constant support from staff to prevent or minimise what would be regarded as “challenging” behaviours elsewhere, to do this staff need up-to-date knowledge of each resident. 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 recorded and staff were heard to speak to residents by the name they wished. There are several residents at the home whose behaviour does on occasion give concern. On care plan seen evidences that these behaviours are managed verbally although there have been incidents with broken property and verbal shouting. The staff are not trained in any physical holding and do not do it. They have been trained in verbally calming someone or other action such as safety in people’s personal rooms. If during the assessment process or at a review, there is indication that physical restraint by staff would be needed, the manager said that either the person would not be admitted or they would Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 13 need to be moved to an environment where staff were trained in those techniques. The inspector looked at the medication administration records, storage and control of stock. For one individual, since admission to the home the medication has been reviewed and in some cases reduced and stopped, whilst this has proven to be good for the individual, the care plan has not been altered to reflect this change, although the review evidences the changes. In another sample the daily notes stated that the resident was ‘ sitting by the front door for much of the morning occasionally asking to leave. Extra PRN given at lunchtime’. There was no indication as to why this behaviour warranted ‘extra’ medication being given. The nurse assisting with the inspector with the medication explained that the staff were aware of the behaviours that were exhibited before a verbal outburst and medication was given to help manage this. The inspector viewed the medication records for the individual and noted that the only medication that was PRN (as needed) was Lorazepam, which has been given three times a day from the 1st November to the date of the inspection. It is prescribed to be given up to three times a day as needed. There is no ‘extra PRN’ medication prescribed. The box was seen and it was noted that the name on the box had been crossed out and the name of this individual added. Another medication record stated that the individual was to receive ‘Procyclidine 55mg in 5ml, give 1x 5ml four times a day, or as needed. This medication is usually given to assist with side effects of other medication and is normally given regularly for this, this had not been given regularly and there was no indication as to why it had been given at all. Generally there was no evidence where an ‘as needed’ medication was given as to the reasons it had been administered and whether the outcome was effective. One individual is on a regime of pain relief, whereby if one pain relief is given the other is reduced, the administration records are very small and it was difficult to identify what had been given. This is of concern for both the individual resident and staff. The inspector spoke with a senior nurse and the manager about all medication issues. Whilst walking around the home the expert by experience did observe the following that should be considered by the management. “I overheard three members of staff having what appears to be a handover meeting at the end of the corridor where residents could overhear them as they passed by. One member of staff said that a resident had had a ‘paddy’ earlier that day.” This evidence was in conjunction with constructive comments about the positive and enabling relationship that was observed between the residents and staff. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents receive good support, to fulfil leisure activities, which are based on their individual abilities and aspirations. Personal support is offered in a way that promotes and protects resident choice. The meals are good generally, with contribution made to special dietary needs and diets however choice for some is limited. EVIDENCE: The inspector was able to speak with a community support worker who enables some individuals in their activities and the hairdresser. The community support worker is self-employed and provides support to five residents at the home over 27 hours a week. He explained the referral procedures as being an assessed need, a referral and a shared risk assessment. Payments are varied depending on the individual’s circumstances for example social services, direct payments from the individual or the home. The support given can be one to one for example ‘nostalgia therapy’, assistance with going to the library, cinema shops or a train journey and Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 15 personal shopping. The support worker also runs a gardening ‘club’ off site and one resident attends there 6 hours a week. He said that the communication with staff was good and that: ‘the staff are very accommodating and helpful, they seem to know what they are doing and the home is very clean’. The hairdresser has been going to the home for several years and is freelance. She said that she has support from the staff to offer her services to those individuals that are bed bound. People at the home are asked whether they want their hair done and how. The inspector asked how this is achieved with individuals who are unable to communicate their wishes verbally, she explained that coming to the home she had developed skills in looking for non verbal communication and staff were again supportive with this. ‘Staff treat each person as an individual and give them the choice of how they want their hair and if they want it done at all, the staff are helpful and caring’. It was noted that care plans indicated individual’s interests and that these were facilitated where possible. There are board games and activities available for residents within the home. 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. 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. The expert by experience spoke with several residents who spoke positively about the recent event that took place in the garden with the ‘Kate Bush’ impressionist. One person had a daily paper delivered. Smoking at the home is situated in one area and supervised by staff for what they feel are health and safety and monetary issues. The expert by experience spoke with some of the smokers who said they felt that only 10 cigarettes a day was not enough and wanted access to smoking more and to hold their own cigarettes. Whilst it is understood the reasons for the staff management of smoking, these comments from the residents have been given to the management. One resident said, “If you missed a smoking session, then you have to wait until the next”, the individual was unhappy at missing out. Samples of menus were seen and whilst they offered some choice and variety these seemed limited for those where the meals had to be softened or liquidised for ease of eating. This has been discussed previously and the manager was going to access advice from a dietician. This has not happened. Where a pureed diet is needed these were seen to be presented as separate items on the plate. Many of the residents are unable to express a preference and information from relatives is sought on likes and dislikes. Several residents Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 16 need assistance and support with their meals and approximately a dozen individuals need to receive their nutrition via a tube. Where there are specific individual needs these were seen to be recorded in care plans and staff were seen to be assisting appropriately. The expert by experience observed some of the lunchtime and found that one resident did not like the lunch that was on offer so staff brought a plate full of sandwiches that were liked. The resident seemed very happy at this. There was also evidence that special dietary preferences were followed with one resident’s in Halal and the home worked with the family to ensure these needs were met. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have excellent knowledge and understanding of Adult Protection issues which protects residents from abuse. Residents can be confident that their views are known to staff and are fully taken into account. The manager has established 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 spoken with and those who returned comment cards, 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 that was being investigated at the time of the last inspection. The allegation was unproven and the home used the example to review its recording procedures and care issues. 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 DS0000012130.V318152.R01.S.doc Version 5.2 Page 18 The expbyexp looked at the residents and their decision-making capacity and how the home considers their safety and risk of the area in which the home is situated. The expert by experience comments that: ”It would seem that most if not all individuals at the home had significant capacity issues. They are ‘de facto’ detained as doors are locked and can only access the outside with support. I was reassured to hear the manager talk about having advocacy as a facility. In light of the Mental Capacity Act, I would be more reassured if this was something available. However, only one man expressed a desire to leave, and others seemed quite happy there, which in a snapshot suggests that being there is more positive than perhaps leaving.” Both the expert by experience and the inspector have spoken with the manager about the new Mental Capacity Act and the locked front door and risk taking. There is evidence that advocates are sought to assist residents at the home although this may not happen as often as may ideally be needed. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 19 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. 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 available evidence including a visit to this service. The premises are suitable for the care of residents with the appearance of the home creating a comfortable and safe environment for those living there. EVIDENCE: The inspector and expert by experience undertook partial tours of the home. There was evidence that resident’s rooms had been painted recently and all communal areas were clean and tidy. There was no malodour detected anywhere in the home. The only issue discussed with the manager was the clinical waste bags being stored before being taken out to the bin and empty boxes and carpet cleaners in the smoking area. The premises are well maintained, with the home having its own maintenance person. There are good internal and external facilities. Communal areas enable service users and staff to have space, comfort and privacy. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 20 The expert by experience walked around the home and made the following observations which were also seen by the inspector: “The temperature throughout the home was alright for the residents and not too hot. It was quite an airy building. Each resident had his or her own bedroom, which was en-suite (although not all are able to use this facility). Residents can individualise their rooms with paintings, pictures etc. Individuals can control the lighting in their room. Some liked the lights off and the room dim. The common areas and passageways had numerous paintings and pictures to stimulate interest.” “There were numerous boxes from a delivery left in the corridor between the main house and the extension. Whilst these were not obstructing anything, they were untidy and a potential hazard. Also, some equipment was also left in corridors, which posed a tripping hazard.” The inspector spoke with the manager about the empty boxes and equipment that were in the smoking area, which is also a through way, to another part of the building. This was the only area where possible hazards were identified in the home. The expert by experience spoke with one resident who uses a wheelchair and found that the individual was unable to reach the electric points in their room as they were either down in the wardrobe or low down behind the bed. The expert by experience asks whether these can be moved to be more accessible. The residents have full access to the main areas and corridors within the home. The expert by experience saw many users walking around, and going onto different levels to visit other areas. The residents are not restricted from any areas except the kitchen, laundry and management/ nurse’s office. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are well looked after by an effective staff group. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to maintain and improve their quality of life. Since the last inspection the recruitment practices have declined with not all appropriate checks being carried out potentially leaving residents at risk. EVIDENCE: The staffing structure provides a broad spread of experience and professionalism: manager, deputy, nurses and support workers. Other health care professionals support the team from outside the home. The duty rota showed how staff are deployed at the home with two nurses and nine support workers during the day and 1 nurse and 4 support workers at night. Nursing staff spoken with said that they have undertaken training recently in mentorship, as the home is registered with Southampton University to have student nurses. The University has also given support staff training in the management of challenging behaviour. Staff training records indicate that all staff are up to date in mandatory training such as first aid, moving and handling and fire, and that nursing staff have undertaken updates in areas such as catheterisation, tube feeding and wound care. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 22 There have been several staff employed by the home since the last visit in January 2006. These records were seen and there was evidence that employment checks had been undertaken with the exception of a check on the Protection of Vulnerable Adults list (POVA). This was discussed with the manager who then spoke with the company they use to carry process the Criminal Records Bureau (CRB) check. The manager is to supply evidence to the Commission that the POVA checks have been undertaken as currently there are staff where a CRB check has not been received or their CRB is not applicable. Since the visit, the manager sent confirmation to the Commission of POVA checks having been carried out and that the recruitment checklist has been reviewed and therefore a requirement is not made on this occasion. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although there are areas for improvement, the home is managed with residents placed at the centre of a service delivery, that in areas exceeds the standards. The manager has a clear vision for the home, which he has effectively communicated with staff. There is clear leadership and staff support and training so that the needs of residents can be met. 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. The expert by Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 24 experience comments that: ” The senior nurse who took me around was very helpful and seemed genuine in this and relaxed at the regulatory visit. The staff appeared to get on well with residents and engaged well with them around their needs for example. The Manager was impressive to me because he thought a lot about his clients and the issues and dilemmas that arose with them.” 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. The manager feels that the home has benefited from this openness combined with the established clinical supervision of staff and auditing of the service by outside agencies and professionals. Resident’s finances are managed through external agencies such as courts or named individuals; the home is not named for any resident. Accounts and records are kept for all residents at the home. It was noted that residents could request monies to pursue activities or purchases. It was seen in the sample of policies viewed on this occasion that they had been reviewed in the last three months. The manager stated that policies are reviewed throughout the year and as needed. A relative’s questionnaire is sent out annually and was sent at the beginning of November 2006. The relatives were generally happy with the service offered at the home. There was evidence that others also audit the home such the University of Southampton, who carry out an annual audit of the clinical learning environment, this was completed in October 2006. Where necessary the inspector has received regular notification of incidents at the home. The proprietor also carries out a regular monthly visit and sends a report to the commission about that visit. The fire maintenance file was seen and there were no concerns identified with appropriate checks and training having been carried out. The risk assessment has been updated in line with changed legislation from October 2006. There is a risk assessment for each room that should be enhanced to incorporate an assessment of individuals in the event of a fire e.g. their mobility needs, behavioural concerns. Staff spoken with confirmed that they had undertaken training recently. The manager had completed a pre inspection questionnaire that indicated that policies continue to be reviewed and other health and safety measures continue. Issues of medication administration and recruitment must be managed consistently to a high standard. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 25 Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 26 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 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 2 Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 12(1),13 (2)18(1) (c) Timescale for action The registered person must audit 31/12/06 the medication system and correct errors in procedures and recording to ensure that medication in the home is accurately managed. The system in operation must be in line with the guidance available from the Royal Pharmaceutical Society. Requirement 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 1 Refer to Standard OP4 OP15 Good Practice Recommendations The registered person should review the current provision of advocacy for residents to ascertain its adequacy. The registered person should seek advice and support for the provision of nutritious and choice meals for individuals where there are specific dietary needs. Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Kitnocks House Nursing Home DS0000012130.V318152.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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