Care Home: Kenroyal Nursing Home

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What the care home does well Service users and their relatives or friends have commented that the staff team are particularly good at making all visitors feel welcome. The Manager and her staff team present as enthusiastic and committed to their roles and their friendliness does mean that service users feel relaxed and able to relate to the staff. The storage and administration of resident`s medication is well managed. What has improved since the last inspection? The Manager has sought up-to-date guidance from the Medical Healthcare Products Agency on the safe use of bedside rails. There have been improvements made to creating care plans which hitherto appeared to concentrate more on meeting the physical needs of the service users but which were less informative on how best to endeavour to meet the individual`s less tangible social needs. These improvements will continue to be made through the process of reviewing these individual plans. What the care home could do better: There were no significant areas of current practice that could be highlighted as requiring further improvement in order to meet required standards other than ensuring that records relating to the managerial supervision of individual members of staff do reflect the number of meetings that actually take place throughout the year. This provides additional verifiable evidence of good practice, which in turn assures service users that the performance of all staff are consistently and regularly monitored on an ongoing basis. CARE HOMES FOR OLDER PEOPLE Kenroyal Nursing Home 6 Oxford Street Wellingborough Northants NN8 4JD Lead Inspector Gary Robinson Unannounced Inspection 10:00 13 December 2007 th 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 DS0000012621.V352341.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. DS0000012621.V352341.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenroyal Nursing Home Address 6 Oxford Street Wellingborough Northants NN8 4JD 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) 01933 277921 01933 277781 kenroyalnh@aol.com Mr Mukesh Patel Mrs Saila Bala Das Care Home 34 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31), of places Physical disability over 65 years of age (31) DS0000012621.V352341.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Kenroyal Nursing Home is registered to accommodate service users in the following categories :Old age not falling into any other category (OP) 31 Dementia over 65 years of age DE(E) 31 Physical Disability over 65 years of age PD(E) 31 2. 3. The maximum number of service users to be accommodated at Kenyroyal Nursing Home is 31 Within the maximum number, one service user (as named in application dated 29/01/07) may be admitted under the age of 65 years in the category of Physical Disability (PD) 28th June 2006 Date of last inspection Brief Description of the Service: Kenroyal Nursing Home is a large property set back off a main street leading into Wellingborough town centre, with ground and first floor bedroom accommodation. There is a lift and stair access to the bedrooms on the first floor. The Home is registered to provide nursing and personal care to service users over 65 years of age. There are twenty-seven single and two double bedrooms with two communal lounge areas and a dining room. There is a large garden area to the rear of the property. Fees are negotiable and currently range from £331.00 to £450.00 per week, but prospective service users are urged to contact the Manager to enquire about fees. DS0000012621.V352341.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This inspection was unannounced and took place over approximately five and a half hours. Kenroyal Nursing Home was inspected using the method of ‘case tracking’. This is a process that involves inspecting the standard of care received, in this instance, by three service users currently in residence, inspecting the records relating to their support and care, and subsequently meeting with them in private to hear their views. There were also meetings in private with three staff members who provide support to the service users, and with the Manager of the Home. These meetings were used to discuss staff roles in providing support and care, training, and the day-to-day running of the Home. There was also a general tour of the premises, including communal areas, although not all rooms in the building were viewed. By agreement with the individuals concerned, bedrooms occupied by service users were also viewed. Records pertinent to the efficient day-to-day administration of Kenroyal Nursing Home were also inspected. The findings of the inspection were verbally shared and discussed with the Manager at the conclusion of the inspection. These findings are incorporated into this report. No requirements were made on this inspection. What the service does well: What has improved since the last inspection? The Manager has sought up-to-date guidance from the Medical Healthcare Products Agency on the safe use of bedside rails. There have been improvements made to creating care plans which hitherto appeared to concentrate more on meeting the physical needs of the service users but which were less informative on how best to endeavour to meet the individual’s less tangible social needs. These improvements will continue to be made through the process of reviewing these individual plans. DS0000012621.V352341.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000012621.V352341.R01.S.doc Version 5.2 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 DS0000012621.V352341.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 4 & 5. Standard 6 does not apply. Quality in this outcome area is good. Prospective service users are provided with the information they need to make a choice about whether Kenroyal Nursing Home is likely to suit them and they can be confident their needs will be assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of previous inspection reports are available to all prospective and existing service users. Information is displayed for visitors to request a copy of a report should they wish to read it. There is documentary evidence on file that service users are fully assessed prior to admission to Kenroyal Nursing Home. The Statement of Purpose and Service User Guide is made available to all prospective and existing service users and provides information about the services provided, the staff team, and management structure. DS0000012621.V352341.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 & 10 Quality in this outcome area is good. The staff team at Kenroyal Nursing Home treat service users with respect and provide appropriate levels of support based upon the assessed needs of the individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans that were inspected had documentation relating to the pre-admission assessments carried out by a designated staff member prior to the service user being admitted to Kenroyal Nursing Home and, in addition, there were also copies of assessments of needs that had been carried out by the placing authorities to establish the suitability of the placement. There is documentary evidence that the staff team record visits to the Home by healthcare professionals and include details of the outcome of the visit and action to be taken. Medicines are appropriately and securely stored. DS0000012621.V352341.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14, & 15 Quality in this outcome area is good. Daily routines are as flexible as possible and the staff team do endeavour to meet the lifestyle needs and expectations of the service users being cared for in Kenroyal Nursing Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities person and within the care plans there was documentation that this member of staff had consulted with residents individually to plan and provide personalised activities. The residents’ notice board displays information about forthcoming events and entertainments. Visitors are welcome throughout the day and service users said their family or friends are always made welcome at Kenroyal Nursing Home. Service users have commented that the food is good. There are service users living at the Home from diverse, cultural and religious backgrounds and the Manager uses an outside catering company to provide foods to meet the dietary needs of these residents. Foodstuffs are appropriately stored. The dining room was clean and pleasant. DS0000012621.V352341.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. Service users and their representatives can be assured that any concerns they may have about the service will be taken seriously and acted upon and the Manager ensures that there is the appropriate training and guidance for staff that enables them to help protect service users from the risk of harm or abuse of their rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is on display within the front entrance lobby of the home, and appropriately included in the Statement of Purpose and Service User Guide. Staff members were able to demonstrate that they knew the procedure to follow if there are any concerns. Advice was given against recording day-to-day niggles in a day-to-day record called the ‘moaning book’ because this might give the impression that service users who are legitimately disatisfied are not being taken seriously or being perceived as causing a nuisance. This advice was fully accepted and it is acknowledged that the naming of this record was not intended to convey this impression. It is evident from discussion and observation of the interaction of staff members and service users that the Manager and staff team are very conscientious and do listen to what service users have to say and take appropriate action to put things right if there is the need to. DS0000012621.V352341.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 23, 25 & 26. Quality in this outcome area is good. Kenroyal Nursing Home is appropriately maintained, comfortable, and kept clean throughout. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Communal areas, including individual bedrooms, within Kenroyal Nursing Home were seen to be clean, comfortable, and free from odour. Individual bedrooms were seen to be personalised with the resident’s own belongings. The premises appeared in a good state of repair throughout. The décor and furnishings are satisfactory, although some bathroom areas would benefit from attention to décor with regard to creating a relaxed ambience. The light fitting in the hallway towards the front of the Home lacked a shade. There is appropriate equipment throughout Kenroyal Nursing Home to enable the staff team to do their work safely and meet the needs of the service users. DS0000012621.V352341.R01.S.doc Version 5.2 Page 13 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 & 30 Quality in this outcome area is good. Staff appear competent, motivated, and respect the service users they support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual members of staff were observed to go about their duties in a competent manner and to relate well to the service users they were assisting. Recruitment of staff is appropriately managed to ensure that service users are protected. There was documentary evidence on file that staff members have a satisfactory Criminal Records Bureau (CRB) clearance prior to taking up their duties. There was evidence of written references and previous employment records. Copies of training certificates were seen on file. Staff have a hand-over at the end of each shift to ensure all staff arriving for duty are fully briefed about the needs of the service users and any action or precautions they need observe to ensure they are being appropriately cared for. DS0000012621.V352341.R01.S.doc Version 5.2 Page 14 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 & 38 Quality in this outcome area is good. Kenroyal Nursing Home is effectively and sensitively managed with the result that the service users can rely upon staff to provide the level of support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments received at the Commission for Social Care Inspection through the nine returned feedback surveys were positive, with service users or their relatives indicating that they were happy with the standard of care being provided. The Manager presents as enthusiastic and committed to providing a good service where service users can feel safe and cared for. Although each member of staff is appropriately supervised in their day-to-day duties and have their performance appraised, the records maintained for staff members do not readily reflect that there have been formal supervision DS0000012621.V352341.R01.S.doc Version 5.2 Page 15 meetings held between each individual and their designated line manager. Advice was given to the Manager and she confirmed this would be improved. There are service users’ meetings and formal resident satisfaction surveys are conducted to regularly check if the Home is being run in the best interests of service users. The health and safety of staff members and service users is protected by compliance with robust procedures and practice governing best practice. Advice was given to the Manager to consider using the checklist provided on the advisory government website for medical devices for the safe use of bed rails fitted to beds of those service users who require such safety equipment to prevent them from falling out of bed. The Manager said she would use this in addition to the risk assessment records already in place. There is a safety poster on display in the medication storage room setting out clear guidelines for the safe use of this equipment and the Manager confirmed that each staff member has been advised of the precautions to take with regard to the safe use of approved bed rails. DS0000012621.V352341.R01.S.doc Version 5.2 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X 3 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 X 3 X 3 2 X 3 DS0000012621.V352341.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP38 Good Practice Recommendations With regard to the safe use of cot-side bed rails, it is recommended that, in addition to the steps and advice already being followed by staff members, the Manager also makes use of the suggested checklist record to be found on the advisory government website: www.medical-devices.gov.uk The records maintained for each member of staff should readily demonstrate that, in addition to day-to-day supervision, they each have had formal one-to-one supervisions with their line-manager at a frequency of not less than six times a year. 2 OP36 DS0000012621.V352341.R01.S.doc Version 5.2 Page 18 Commission for Social Care Inspection Edgeley House Tottle Road Riverside Business Park Nottingham NG2 1RT 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. 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