CARE HOMES FOR OLDER PEOPLE
The Kensington Nursing Home 40-42 Ladbroke Road London W11 3PH Lead Inspector
Peter Montgomery Unannounced Inspection 14th November 2005 11:30 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 The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 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. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Kensington Nursing Home Address 40-42 Ladbroke Road London W11 3PH 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) 020 7727 8033 020 7727 9712 smallcupa.com Goldsborough Limited Mrs Christine Small Care Home 53 Category(ies) of Dementia (16), Physical disability (34), registration, with number Terminally ill (3) of places The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th November 2004 Brief Description of the Service: The Kensington Nursing Home is an attractive building, which has been extensively extended to provide the current level of accommodation. 53 people who require residential and nursing care live in single bedrooms with en suite facilities on three floors. Each floor comprises of a nurses station, lounge and dining area, a small kitchen with tea and coffee making facilities, and specialist toilets and bath/shower rooms. Offices, the conservatory and dining area, plus the main kitchen and ancillary areas are on the ground floor. There are attractive gardens with walkways and seating areas to the rear of the home. Décor, furnishings and equipment are of a good standard, and are generally well maintained. A passenger lifts provide access to the upper floors of the home. No on-site parking is available. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Monday 14th. November 2005. Communal areas were viewed, the people who live in the home, visitors and staff on duty were spoken to in the lounges and in private. Individual and communal records including service users records and daily records - were reviewed, and these were used to inform the report. What the service does well: What has improved since the last inspection? What they could do better:
The home has a policy where service users are able to smoke in their bedrooms, however concerns regarding cigarette smoke permeating into other persons rooms (with the obvious associated risk to other service users from passive smoking) were raised during the inspection. It is a Requirement that
The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 6 health and safety policies and risk assessments concerning smoking in the home must be reviewed, and the proprietor consider the installation of air filtration systems in these bedrooms, to prevent smoke contamination of other areas. 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 Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 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 the following standard(s): 1,2,3,4,5,6 The Statement of Purpose and Service user Guide is well written and provides information in a variety of formats for users to be aware of the services available. People who use the service have their needs appropriately assessed. EVIDENCE: The Statement of Purpose and Service User Guide are detailed and address the core objectives clearly. Records and individual assessment information demonstrated staff apply the aims consistently, and individuals are admitted with a detailed assessment of how their needs can or may be met in compliance with this objective. A number of service users were spoken to, and all indicated they considered their needs were being met, in addition service users stated they had visited the home before moving in and were satisfied with services and the facilities. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Individual plans of care for each person are detailed and generally provide staff with the information need to meet individual needs. The participation of service users and their relatives is encouraged so that plans reflect as accurately as possible the needs and wishes of the individual. EVIDENCE: The records for six-service user on each floor were looked at and each contained a plan of care, which set out the needs of the service user and how they were to be met by staff. Whilst there was evidence they were being reviewed regularly in consultation with appropriate care professionals, it was considered – as they are hand written - many were difficult to read. It is a recommendation that the new care plan formats currently being developed address these issues. Service users are supported to make decisions and take risks as part of their independent lifestyle, and each person’s file contained an assessment of any areas where there was considered to be a risk and how these risks were to be addressed. Service users have been involved in the development of the care plan and agreed their objectives, and the range of activities planned. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Links with the community are good and they support and enrich service users social opportunities. Service users, particularly those with more specialised needs, benefit fully from a varied and stimulating range of activities and outings. EVIDENCE: There is evidence of a varied programme of activities, facilitated by the two activity coordinators and that staff accompany service users on outings where appropriate. Evidence throughout the home, plus feedback from service users confirmed that most considered activities good, particularly for those with specialised needs. However, although there are seasonal events such as barbeques etc. a number of service users commented they thought individual activities - such as visits to the shops or a cafe could be facilitated. The variety and quality of the meals provided are imaginative and include both vegetarian and ethnic choices, Menu planning, particularly in the variety and quality of the food available, demonstrated that choice and individual preferences are well catered for in the home, and many of the residents spoken to said how much they enjoyed the food. The home is commended for the quality of meals provided. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 The home has a well-developed complaints system, there is considerable evidence that service users views are listened to and acted upon. EVIDENCE: All service users are given copies of the complaints procedure (in the service user guide) when they are admitted into the home, and a record of all complaints made in the home is retained on file by the manager. Service users spoken to are generally aware of the complaints process and all stated they feel able to discuss concerns with staff. Five complaints have been recorded at the home since the last inspection and these were satisfactorily concluded within specified timescales. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 There have been no significant changes to the décor and furnishings in a number of areas in the home in the last year; service users live in a pleasant environment. EVIDENCE: Facilities, furnishings, décor and standards of cleanliness throughout the home are all appropriate and well maintained. The home is modern, with accommodation arranged over the first, second and third floors. Each floor has a small lounge, and a kitchen, although most service users take their meals in the large ground floor dining area and conservatory. Resident’s bedrooms are all provided with en suite facilities, and are individually decorated with personal memorabilia. Service users comments demonstrated they were satisfied with the standard of accommodation and their rooms in particular. Communal areas are all well decorated and maintained, in the last year a new library has been created, and some communal areas recarpeted. The inspector was made aware of concerns regarding smoking in the home, and smoke contamination affecting other service users rooms (with the obvious associated risk to health from passive smoking). Health and safety policies and risk assessments
The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 13 concerning smoking in the home must be reviewed, and the proprietor consider the installation of air filtration systems in smokers bedrooms, to prevent smoke contamination of other areas. This is a Requirement. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Service users benefit from a qualified and experienced team of staff at the home who have the skills and training to meet their needs. EVIDENCE: Staff competencies and their friendliness was commented on by service users, a number of staff have worked at the home for a number of years and have built up a good knowledge and understanding of the needs of each service user. Staffing levels comprise of two registered nurses and four support workers on each of the four wards during the day. Support staff have undertaken training in essential areas, such as food hygiene, health and safety, and first aid. The manager stated 80 of staff have completed NVQ level 2/3 training, with a further six due to start training later this month. This commitment to staff development and training by senior staff should ensure service users receive a good standard of support and care from the staff at the home. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 The manager has a development plan for the home and is well supported by senior staff. All staff are aware of their roles and responsibilities. EVIDENCE: The manager is a registered nurse, and recently gained NVQ level 4. Staff strive to achieve appropriate standards for the home and feedback from users of the service was positive. Staff on duty stated regular meetings with residents are scheduled to determine their views, and access to external advocates is provided as required. A number of records were looked at, including care plans, risk assessments, staff rosters etc. These records were generally detailed and accurate, and record keeping overall demonstrated the home is being run responsibly with essential checks being made and acted upon. The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 17 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 25 Regulation 13[4] Requirement The provider must ensure health and safety concerns are addressed, this may require the installation of air filtration systems in bedrooms. Timescale for action 16/01/06 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 The Kensington Nursing Home DS0000026016.V266076.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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