Inspection on 15/08/05 for Kynaston Court

This inspection was carried out on 15th August 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kynaston Court 20/10/06

Kynaston Court 07/03/06

Kynaston Court 01/03/05

Kynaston Court 27/08/04

Kynaston Court 12/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

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Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOMES FOR OLDER PEOPLE Kynaston Court Country House Retirement Home Hentland Ross-on-Wye Herefordshire HR9 6LP Lead Inspector Wendy Barrett Unannounced 15 August 2005 10:00 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. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kynaston Court Country House Retirement Home Hentland, Ross-on-Wye Herefordshire HR9 6LP 01989 730678 01989 730664 Address 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) Mrs M M Swaine Mrs M M Swaine Care Home 20 20 20 20 Category(ies) of Dementia over 65 years registration, with number Physical disability over 65 years of places Old Age Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user who is aged over 65 years and in addition has a learning disability. 2. One named service user who is aged under 65 years who has dementia. Date of last inspection 1 March 2005 Brief Description of the Service: Kynaston Court was built as a college of theology and was first registered as a care home in 1984. The registered person (provider and manager) is Mrs Monika Swaine who has been a registered person in respect of the home since 1987. The home is registered to accommodate 20 male or female residents over 65 years of age who have care needs arising from the normal ageing process. They may also have dementia related needs or a physical disability. One named service who is over 65 years of age has a learning disability and one other named resident who has dementia is under 65 years of age. There are conditions of registration that allow these two individuals to be accommodated at the home. They were still resident at the time of this inspection. The home is located in a rural setting in the village of Kynaston, about six miles from the market town of Ross-on Wye. There are no village facilities within walking distance and the nearest main bus route is about half a mile away. The property comprises a large detached period house with an annexe set in about an acre of mature and well-maintained grounds.The accommodation available to the service users includes twelve single and four shared bedrooms that are located on the ground and first floor, with a chair lift to access the upper floor. There are two sitting rooms, a separate dining room, and a substantial conservatory available as communal space. The gardens are accessible and provide a suitable, safe and pleasant area for service users. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was undertaken between the hours of 10am and 4pm. Fifteen residents were accommodated at this time. The Provider/Care Manager was away on holiday and the Deputy Manager was in charge during her absence. She was present at the home throughout the day. A Team Leader helped with an inspection of care records and a Senior and care assistant were interviewed. There was also discussion with the cook. Many of the residents have dementia related needs and were unable to be interviewed. It was possible to speak to four residents and others were met and observed in the communal areas of the home. The Provider had been asked to distribute feedback questionnaires to staff employed at the home. Unfortunately only three replies were received. These were all positive with no issues of concern identified. What the service does well: Some residents are more reliant on staff to help them go about their daily lives, but all residents appear dignified and relaxed. This suggests that the staff can vary their approach so that everyone is safe but no-one loses their right to make choices when they can safely do this. Written plans of care are used well by the staff to help them make these judgements. There are enough staff employed at the home to give them the time to care for residents as individuals. There is a lively but relaxed atmosphere even though some residents are frail. The residents make full use of communal areas, their bedrooms and the garden. The accommodation is well maintained with good attention to potential risks for the residents who live at the home. The staff receive training to give them the particular skills they need to do their job well. The training needs of each staff member are monitored so that everyone gets the instruction they need. The staff feel well supported by the senior staff. The food is good quality and it is safely stored and handled. The residents like the meals and they are offered alternative choices if they are unwell or don’t like the planned dish. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: There must be more careful attention to recruitment so that all applicants are subject to the full procedure defined in legislation regarding the protection of vulnerable adults. This is the best way to be sure that new staff are suitable to work with the residents. The staff file should record how this work has been done. There are a few, isolated examples of unfinished work relating to safety and hygiene although the majority of the work has already been completed. It is particularly important that staff do not wedge open the laundry door because the wedge stops the door closing automatically in the event of a fire. It can also cause the door to warp and then it won’t fit securely into the doorframe in the way a firebreak door must. Some residents may appreciate it if they are better informed about future menus. It’s nice to be able to look forward to a favourite meal (or ask for something different well in advance). The type of book that is being used for recording staff accidents should be put into use for recording residents’ accidents. Then both will comply with the Data Protection legislation. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 7 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. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 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 standard(s) None EVIDENCE: The above standards were not inspected. There is a Statement of Purpose and Service User’s Guide. The Provider intended to revise them to bring the information up to date following the last inspection. A resident described how she previously lived in another care home close by. This home was closing and her son helped her to find alternative accommodation. Although the first bedroom she occupied was on the first floor she was subsequently offered a ground floor room. Having been able to view this room she decided to accept it and is now very happy that she did. Her friend, who also came from the closing care home, is close by and they spend a lot of time together. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 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 and 8. Residents health, personal and care needs are met with guidance for staff in individual plans of care. EVIDENCE: A Team Leader helped with inspection of the individual plans of care. She was fully conversant with the system of recording and was able to access relevant information easily. A care assistant was able to describe in detail the health and personal care needs of a resident. This included reference to personality changes arising from a dementia, family contacts, interests, a medication regime for pain control, manual handling assessment in the care record and pressure area care. A recently appointed Senior Care Assistant was present at the home on the day of the inspection. Although she was formally off duty she had come in to read the care records. She was particularly interested to familiarise herself with the care needs of two residents she would be taking a special interest in. This arrangement is known as ‘key working’. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 11 A resident said she could have a bath when she wished. She enjoyed a Wednesday bath and her reluctance to alter this arrangement had been accepted by the staff. She noted that staff always check the bath water temperature with a thermometer before helping her in. Another resident pointed out a pile of clothing that had been returned to her from the laundry. She was very happy that she gets clean laundry every day. Care records included references to attention from a district nurse in dressing a leg ulcer, chiropody and G.P. visits. Other residents seen around the home had clearly been given appropriate support with their personal presentation e.g. clothing, hair care. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 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, 14 and 15 Residents experience a stimulating and varied life at the home. When necessary, staff help them to pursue their interests. EVIDENCE: Residents were observed moving freely around the communal areas or in the garden. Some preferred the privacy of their own room so they could read, watch their television, listen to their radio, or sit quietly. A care assistant spoke of a resident’s love of gardens. ‘We point out the flowers and birds from the conservatory window’. The resident usually sits in this room. Her plants are in the room so she can continue to enjoy them. She cannot go into the garden without staff assistance – ‘but she soon feels the cold’. Another resident has her own plant bed in the garden. She said she had no gardening tools but apparently has actually been given some hand tools. There was a bird table in the garden and the resident enjoyed putting out the food for the birds. One of the gentlemen has a shed where he can pursue his interest in carpentry. The bedrooms seen on the day were very attractively presented with many personal items reflecting the occupant’s interests and personality e.g. books, Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 13 plants, paintings done by a resident and displayed on her bedroom wall. One lady had chosen to have a ‘lie in’ but was happy to chat as she rested in bed. There was reference in a care record to a visit from a church minister. The cook was aware of residents dietary needs and preferences e.g. ‘won’t eat anything fried so having an alternative meal today of corned beef, salad and jacket potato’. Of an unwell resident the cook said – ‘she enjoys home-made soup’. A resident mentioned that she was always asked what she would like for her breakfast. She remembered having fresh kidney beans, carrots and leeks recently. She was not offered a choice at lunchtime and did not know what was on the menu for lunch on the day. She didn’t care – ‘I’m not fussy’, but she did comment on ‘really nice food – like trifles’. The record of food recorded that banoffee trifle had, indeed, been served the previous day. Some residents may enjoy having information about future meal plans so that they can look forward to favourite dishes or request alternatives. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 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) None EVIDENCE: The Commission has not received any complaints about the service during the past twelve months. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 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) 19,20,23,24 and 26 Residents have an attractive, safe and well maintained environment with hygiene given good attention. There are one or two specific pieces of work that may need further attention if not already addressed. EVIDENCE: There is ongoing investment to ensure the quality and safety of the accommodation. Staff have been supplied with a bath thermometer to check water temperatures, most heating radiators have now been covered (bedroom 11 had not), paper towels have been supplied to improve infection control. One or two areas still needed this facility e.g. ground floor toilets had liquid soap but not yet paper towel dispenser. There is a sluicing programme in the washing machine. The kitchen was clean and tidy and food was stored well in the fridges. Opened foods were appropriately covered and date labelled. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 16 A care assistant felt that the home was very well maintained with repairs dealt with quickly. All areas visited during the inspection were clean and bright. There were residents’ personal belongings around the home, giving it a homely, lived in feeling. There was no mal- odour anywhere in the home. The dining room was very attractive – cloth tablecloths, paper serviettes and each table with a potted cyclamen as a centre piece. Although records of premises risk assessments were not inspected one or two potential risks were observed and should be risk assessed if not already done i.e. Upstairs bedroom window without restrictor, resident’s rugs possibly creating tripping/slipping hazard. Care records do include risk assessments of the bedroom and this may, therefore, have been addressed already. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 17 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) 27,29 and 30 There are enough staff to meet the residents needs and they are well trained and supported. Residents will be better protected if the homes recruitment policies and procedures comply with legislation and are robustly applied all the time. EVIDENCE: A care assistant felt that there were enough staff to meet residents needs. There was no longer any need to employ agency staff. Observations of attention given to the most dependent residents supported this view. Two staff files reflected some good practice in respect of recruitment e.g. application forms, employment history, copies of training certificates. There were, however, important omissions. There was no record of references being obtained for one staff member who had already commenced work at the home and had been employed in a supervisory capacity. Although the Provider already knew her because she had been helping her with administrative work, this prior knowledge cannot replace the formal procedure for checking suitability. The Provider has subsequently confirmed that two verbal references were actually received. This work should be recorded in the file and there must be a written reference sought from the most recent employer. No photographs or evidence of identity were in either file and only one file contained a CRB (Criminal Records Bureau) disclosure obtained by the current employer. An application had been made for the second employee but she had already commenced duty. Portable CRB disclosures are no longer acceptable Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 18 since the introduction of POVA(Protection of Vulnerable Adults) register checks as part of the CRB application. When it is essential to start new staff before the receipt of a CRB disclosure there must be evidence of a POVA first check. The new staff member must be supervised at all times by an existing staff member who is competent to undertake this task. The arrangements for this supervision should be recorded in the staff file. Staff are receiving training. NVQ training for all staff is ongoing. There has been training in health and safety and care practice e.g. dementia care and infection control. There is a record at the home showing each staff member’s training programme. A care assistant was in the middle of a stage 2 course on medication and an NVQ level 3 award. Her future training needs had been agreed at a meeting with the Provider soon after she started work at the home. All staff are paid to attend all training. The cook had completed food hygiene training in May 2004 at her previous employment. She had received manual handling instruction at Kynaston Court in June of this year. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 19 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) 33,36 and 38 The home is managed efficiently to protect the interests of the residents. Staff feel well supported and are supervised by competent seniors as they go about their everyday work. EVIDENCE: A care record included feedback questionnaires dated April 2004 and April 2005. The Provider was developing a Quality Assurance system at the time of the last inspection. This would include consultation with residents. Progress will be reviewed at a future inspection. A newly recruited member of staff was very impressed with the genuine interest and care of staff for individual residents. There are many frail residents at the home and they depend heavily on staff to protect their dignity and self-expression. Observations made during the inspection supported the view that staff do work with the best interests of residents as their priority. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 20 Staff felt well supported everyday and in a more structured form. A staff file contained a record of appraisals in July 2004 and May 2005. The Provider and senior staff had attended Supervisory training through Cirencester college. A completed workbook was seen at the home. It showed a comprehensive programme. This report makes reference to attention to health and safety e.g. recorded risk assessments, premises safety, infection control measures, staff training. The use of a wedge under the laundry room door stops the automatic closure from working in response to the fire alarm. The laundry is a high-risk area in respect of fire hazard. The wedge was removed when this was pointed out during the inspection. The Commission is receiving reports of notifiable events at the home, as required under Regulation 37 of The Care Homes Regulations 2001. The staff accident record complies with Data Protection legislation but the record of accidents to residents will also need to comply. A record of food provided was being maintained, and there was also a kitchen cleaning schedule and records of food and fridge/freezer temperature checks. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 21 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x x 3 x 2 Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 33 Regulation 24 Requirement The registered person must establish and maintain an effective system for reviewing and improving the quality of care at the home, in consultation with residents and other stakeholders. (Not fully reviewed at this inspection, so carried forward) All recruitment must be processed in line with substituted Schedule 2 to the Care Homes Regulations 2001 (9th July 2004) The practice of using a wedge to hold open the laundry door must either permanently cease or be justified within the fire risk assessment record. The record of accidents to residents must comply with Data Protection legislation. Timescale for action 31st October 2005 2. 29 19 Immediate and ongoing 31st August 2005 3. 38 23(4) 4. 37 17 30th September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 23 Kynaston Court Country House Retirement Home 1. 2. 15 19 Some residents may appreciate more information about future menu plans. The work already completed on risk assessing the bedroom accommodation should be checked to make sure it covers things like rugs, unrestricted upper floor window openers. Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN 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 Kynaston Court Country House Retirement Home E52 - E02 S24720 Kynaston Court V244717 150805 Stage 4.doc Version 1.40 Page 25 - 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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