Care Home: Kilfillan House Nursing Home

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What the care home does well People living at Kilfillan House and their relatives are positive about the service they are receiving and their relationships with staff. A relative told us you feel as though you are a `member of a family`. People value the consistency of the staff team, which means they are being supported by people they know. One person said `It is peace of mind that our relative will see the same friendly faces during their day to day care`. Admissions are well managed, making sure that people arriving from hospital have early access to a doctor to review their medical needs. People have their nursing needs met in a homely environment surrounded by furnishings they would be familiar with. A relative told us ` We still continue to be very impressed by Kilfillan. Not only the high standard of care and nursing but the ability to keep a very homely feel within the structure of a nursing home`. There is a good ratio of nurses to care staff on each shift to provide the nursing care people need. People are being supported by skilled care staff who have achieved National Vocational Qualifications in care, at a level above national standards. People feel they are listened to and any concerns they have are addressed before they become problems. What has improved since the last inspection? A consistent management and staff team have been established at Kilfillan House. This means they can continue to improve and develop the service, as they listen to the people who live there and in response to BUPA`s own quality assurance results. The activity organiser has been provided with training and is continuing to develop the activity program to support the needs of frail older people. What the care home could do better: BUPA are promoting a high quality service at Kilfillan House but some of the environmental standards, in relation to the layout of the building, individual rooms and staff facilities do not reflect the changing patterns of admissions over recent years, as people with more complex conditions are admitted. We have suggested that the lunch time arrangements are reviewed, to reduce levels of activity, noise and interruptions at meals times. This will enable people to enjoy their meal and those who need assistance to have the full attention of staff. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kilfillan House Nursing Home Graemsdyke Road Berkhamsted Hertfordshire HP4 3LX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sheila Knopp     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Kilfillan House Nursing Home Graemsdyke Road Berkhamsted Hertfordshire HP4 3LX 01442877115 01442877598 springc@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (BNH) Ltd care home 32 Number of places (if applicable): Under 65 Over 65 32 0 0 old age, not falling within any other category physical disability terminally ill Additional conditions: 0 5 1 The home may accommodate one named service user who has not yet attained the age of 65 years, under the category of TI This home may accommodate 32 older people who require nursing care. This home may accommodate 5 people (aged 50 or more) in need of convalescent nursing care. This home may accommodate 5 people (aged 50 or more) with physical disability who require nursing care. This home may accommodate up to 10 service users who are terminally ill. Date of last inspection Brief description of the care home Kilfillan House is situated in a quiet residential road about half a mile from the town centre of Berkhamsted. The front of the building is mainly used as a parking area bordered by some mature border plants and trees. Parking is also available on the road Care Homes for Older People Page 4 of 27 Brief description of the care home outside. The entrance leads to a large reception area and dinning room. The administrative office is to the side of the reception area. Single rooms, of varying sizes, with en-suite toilet facilities are located on the ground and first floor. Some of the ensuite bathrooms are not suitable for people with mobility problems, as space is limited. Shared assisted bathrooms, shower and toilets are available. The home has a lounge that leads to a large conservatory that is used as a second lounge/activity room. The conservatory leads to an average size garden with seating areas for the service users and visitors. Part of the garden has been developed into a Sensory Garden and there is a greenhouse for residents to use. Fees currently range from 1000- 1500 pounds per week depending on assessment and funding arrangments which may vary. Information about the service provided, in the form of a Statement of Purpose and Service User Guide, are available on request from the manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Our last key inspection took place on 11/4/07. At the time we assessed that the people who live at Killian House were being provided with a 2 Star - good service. The information we continued to receive between our inspections indicated that there have not been any changes, so we carried out an Annual Service Review (ASR) on 7/4/08. An ASR does not include a visit to the service. The information in this report is based on a visit to Kilfillan House by one inspector. We looked at the information we have received since our last review. This includes information about any complaints we have received, notifications that tells us about incidents and accidents in the home and the managers Annual Quality Assurance Assessment (AQAA). The return of the AQAA is a legal requirement. It provides us with Care Homes for Older People Page 6 of 27 information about the service and some numerical data. The AQAA was returned to us within the timescales requested. The information provided a reliable assessment of the service provided at Kilfillan House. We have not received any complaints about this service between our reviews. To make sure we have included the views of people who live, visit or work at Kilfillan House we sent surveys to residents, relatives, staff and health and social care professionals. The views of 3 residents, 2 relatives, 7 staff and 2 health professionals, who returned surveys, have been included in this report. We also had conversations with residents and staff, in private, during our visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the assessment of their needs, before coming to stay at Kilfillan House, will takes account of their individual wishes and information from people who know them. This is to make sure that staff; are able to provide appropriate levels of nursing care, specialist nursing equipment is in place and medical practitioners are on hand to review their needs shortly after admission. Evidence: We met with a new resident to hear about their experience of moving to Kilfillan House. They confirmed that the staff were kind and very good. The management of their meals was an important issue for them and they had met with the chef. Before they came to stay the manager had carried out an assessment of their needs. This is to make sure that the home is able to provide a suitable service for them. A detailed care plan had been put in place to provide staff with the information they need to support each person according to their individual wishes. Detailed information is also Care Homes for Older People Page 11 of 27 Evidence: obtained from other people involved in caring for the person concerned. The majority of people coming to stay at Kilfillan House are admitted directly from hospital. The staff also work closely with St Francis Hospice in Berkhamstead. The manager reported that she actively manages admissions to make sure a general practitioner (GP) or hospice staff are available to see the person being admitted as people are often very frail. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their health and personal care needs will be met in a way that is sensitive to their individual preferences and supports their privacy and dignity. Evidence: People told us they were happy with the care and support they receive from staff. One person told us their relative was extremely well looked after. Another person said staff understand and meet peoples individual needs. People had received good attention to their personal care and hygiene needs. Residents spending time in bed looked relaxed and comfortable with drinks and call bells to hand. Each person had a plan of care that details their personal care, health, emotional and social needs. These records are kept up to date as changes occur so people can make decisions about peoples health and welfare. Risk assessments are put in place to support peoples safety and direct staff on the procedures to follow, when they are Care Homes for Older People Page 13 of 27 Evidence: using moving and handling equipment, specialist seating and bed rails. We recommended that one persons care plan was updated, to include details of the approach staff should take when providing assistance and encouragement. This was so staff could be consistent and the person knew what to expect. People have good access to community, hospice and hospital based health care professionals to provide additional support and treatment when required. There are regular visits from the local hospice team to support residents and staff. There is a training plan in place to keep staff up to date. Policies and procedures are regularly reviewed to make sure staff have up to date information on clinical practices. We have advised the manager to review the systems for testing blood glucose levels to make sure all elements of the testing kit, including the glucometer, are for single patient use as the products indicate. This is to prevent transfer of any potential infections. There are good systems in place to make sure that people are having their prescribed medicines safely. However the medication storage area is very small and staff have to keep supplies in a second locked area. Established links with the local hospice and the experience of staff, means that the needs of people and their families are supported at the end of their lives. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with opportunities to take part in activities and events designed to provide stimulation and a sense of well-being. People are offered a choice of freshly cooked meals that they like and meet their dietary requirements. However staff need to be more aware of the atmosphere created at meal times so people can eat their meals without distractions. Evidence: The importance of providing a stimulating environment to promote peoples sense of well-being is recognised by staff within the home and the resources are allocated by BUPA. The importance of involving all staff in providing social support is recognised. An activity organiser is employed and training in providing activities for older people is available. BUPA have introduced new records to record the level of interaction people have and the range of activities provided. The activity organiser is also able to receive support and share ideas with colleagues working in other BUPA care homes. The need for one to one contact with people during the day is a recognised part of Care Homes for Older People Page 15 of 27 Evidence: caring for frail older people who may spend their time in bed. The importance of belonging to a wider community is addressed by having visiting church representatives, resident involvement in fund raising for charities,resident meetings, celebrating national events and inviting neighbours to tea. Taxi vouchers are applied for in lieu of bus passes so people can go out on trips. We were told that an exercise session is very popular. We had lunch with the residents. The people we spoke to during our visit were positive about the choice and quality of the freshly cooked meals they are served. People are able to make special requests and have contact with the chef. Dietary needs and preferences are catered for. Hospitality is offered to support families visiting the home and partners who continue to maintain their relationships by spending each day at Kilfillan House. We observed that the management of the meal could be better organised so meal times are protected from intrusions and a social atmosphere is created. There were distractions from people walking through the dining room,including at one point a food delivery. Where people need assistance it would be helpful to allocate one member of staff to sit with them and help. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be listened to and any concerns they have will be addressed, taking account of their individual needs and preferences. Evidence: People express a high level of satisfaction with the service provided and confirm, they are treated as individuals and staff listen to what they say. Information on how to raise concerns is available to people living at Kilfillan House. We have not been contacted by any one receiving a service or health and social care professionals, who have regular contact with residents, between our inspections. The self assessment completed by the manager (AQAA) states that no formal complaints have been received about the service in the last 12 months. The manager reported that BUPA are currently reviewing the complaint procedure. There is an open management culture that welcomes the views of people living at Kilfillan House, their relatives and staff. Resident, relative and staff meetings encourage people to exchange views and influence the running of the home. Staff understand their responsibilities to report any issues that may have an effect on the care of residents and receive training in protecting vulnerable adults. The manager is aware of local procedures for referring any incidents, that have implications for the protection of residents, to the local authority who are responsible Care Homes for Older People Page 17 of 27 Evidence: for carrying out investigations. However there have been no reported incidents between our key inspections. The manager is also aware of the implications of the Mental Capacity Act in relation to peoples ability to make decisions about aspects of their lives and makes use of advocacy services when people need an independent view. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are living in comfortable well maintained surroundings that provide a homely environment with many features of interest. However in recognition of the quality of service BUPA are promoting at Kilfillan House, future residents would benefit from a refurbishment of the premises to provide more suitable amenities for people with complex nursing needs. Evidence: People express a high level of satisfaction with the upkeep of the home, grounds and cleanliness of their rooms. The managers self assessment (AQAA) told us that over the last year a sensory garden had been created for residents and work had continued on painting bedrooms and replacing furniture, where required, to maintain standards. Kilfillan House provides accommodation within a country house style environment for residents. There are pleasant day areas, points of interest, furniture, fittings and soft furnishings to match. Residents are able to bring personal possessions with them so they can make their room their own. Staff manage to maintain this homely, informal atmosphere despite the high level of nursing care people require. However the environment does have an impact on the care provided and BUPA should take steps to review this and carry out a refurbishment Care Homes for Older People Page 19 of 27 Evidence: of the premises to reflect the pattern of admissions from acute services that have taken place over recent years. There is lack of storage space for medicines, clinical equipment and nursing records. The implications of this are that the medicines are having to be stored in two separate places. Staff have to move the medicines trolley into the corridor to use hand washing and gain access to work surfaces and storage cupboards. The nursing records are kept in an open area off the main hallway. Clinical equipment is kept on open shelves and the disposal box for discarded sharps was on the floor. An ambulance crew had to transfer a resident being brought into the home from a stretcher on to a wheelchair in the dining room. This was because the corridors are too narrow, at some points, to take a stretcher. All concerned made sure the dignity of the individual person was protected during this process. However there are implications for managing this process in an area where people are due to eat. Some of the rooms have en-suite bathrooms. These are no longer used as they too small and the equipment is unsuitable for people with mobility problems. The shared bathrooms and shower room are very sparse and functional. Equipment is stored in these areas. We referred to these issues in our last report but understand a refurbishment has been postponed. Laundry and cleaning procedures are designed to meet current infection control standards. Staff have access to the personal protective equipment and training they need prevent the spread of infection. People are provided with freshly laundered bed linen and clothing. However the laundry is very small and situated in the same narrow corridor as the kitchen. To promote good infection control practices, staff need to make sure they are able to access hand washing facilities in the laundry and soiled linen is delivered to the laundry at a suitable time so a clean / dirty route is created. These areas have a tendency to become cluttered. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a regular team of staff who they have confidence in and understand their individual needs. Evidence: People living in the home express a high level of satisfaction regarding the support they receive from staff. The information we have from our own inspections and BUPAs own quality monitoring reports indicates that this is consistently maintained between our visits. A health care professional who completed a survey said they felt that the current staff group were of a high quality. The staff we interviewed and observed during our visit demonstrated a positive approach to the care of the people living at Kilfillan. Residents mentioned staff by name. Staff who completed surveys were positive about the management support they receive and demonstrated their commitment to providing good quality care. One person spoke of providing a caring and reassuring environment for residents. Another person spoke of good team work. Staff told us the staffing levels were good but one person felt staff were sometimes put under pressure if peoples needs were high. The staffing numbers on each shift and ratio of nurses to carers provides a suitable skill mix for the people living in the home. No agency staff are used. The people living Care Homes for Older People Page 21 of 27 Evidence: at Kifillan House place great importance on being supported by regular staff that they know. We looked at the personnel records for four newly recruited staff. The required checks on peoples work history, criminal background and health status are all carried out. The professional identity numbers of the nurses employed at Kilfillan are verified, to make sure they are registered to practice, with the Nursing & Midwifery Council. There are systems in place to make sure that staff get the training they need as they start work in the home and to update their practice and continued professional development at regular intervals. The managers self assessment (AQAA) states that 56 of the care staff have National Vocational Qualifications (NVQ) in care. This is above the national 50 level set for care staff to achieve. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Kilfillan House can be confident in the service because it is well managed and the quality assurance systems in place make sure that standards are maintained consistently over time. Evidence: The people living at Kilfillan House are provided with a consistent well managed service. The company assessment of the manager completed in 2008 confirmed that 9 out of the 10 areas rated by staff were higher than the national average for BUPA managers. BUPA has quality assurance systems in place that require regular reporting to senior managers within the company and cover all aspects of the service. These are designed to provide an early warning of any emerging problems. Senior managers also make regular visits to Kilfillan House and provide a report on their findings to the manager and directors of the company. Our surveys and the BUPA Customer satisfaction survey Care Homes for Older People Page 23 of 27 Evidence: for 2008 both reflect good outcomes for people using the service. This means we can be confident that the information we are provided with reflects the standard of service provided. Detailed invoices provide people with a breakdown of fees and additional charges such as hairdressing, newspapers and chiropody. The health & safety records we saw confirmed that the checks required on equipment and systems within the home are regularly maintained and serviced. This included details of regular checks on fire safety equipment. Detailed checks on moving and handling equipment, wheelchairs and bed rails are carried out to make sure they are safe and comply with health & safety legislation. The training records and managers self assessment (AQAA) confirm that staff are provided with the health and safety training they need to ensure safe working practices. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 In line with BUPAs approach to providing a quality nursing service at Kilfillan House we would like the company to share their plans for the future development of the premises with the Care Quality Commission. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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