Care Home: Kingfisher Nursing Home

What the care home does well Feedback from people using the service, their relatives and staff was positive. One resident said that this `home is good, staff are very caring, food is nice and there is a variety of activities organised for us`. Another person said `we are being well cared for and being well looked after`. There is a welcoming and relaxing atmosphere within the home. The premises are well maintained, clean and fresh. Care plans are `person centred` detailing how staff were supporting residents in meeting their identified needs. People receiving specific nursing care have a detailed record of their treatment and the support they received from other health professionals. The management and administration of medicines were kept in good order and records showed that there are regular audits to ensure that safe practices are manintained. The staffing levels meet the needs of those living at the care home and staff are knowledgeable and dedicated to ensure the needs of the individuals are met. The care home has a good structure in place with good auditing processes in ensuring standards are met in the best interest of people using the service. In relation to equality and diversity, the manager has stated in the AQAA that there is an equal opportunity policy which includes race, gender, disability, sexual orientation, age, religion, that are firmly adhered to and staff receive training to ensure that these policies are followed. What has improved since the last inspection? The management team is proactive and has developed an ongoing quality assurance system to ensure that the views of people using the service are listened to and acted upon wherever possible. As stated in the AQAA, during the last twelve months, the home has now a nursing team and a key worker system in place to provide a continuity of care for people using the service. Some of the bedrooms have been fitted with new carpet. A variety of activities are now being planned by the day care activity co-ordinator. What the care home could do better: Care plans for pressure ulcers should include the type of pressure relieving mattresses or other equipment provided and the advice from the Tissue Viability Nurse sought. A specific care plan should be devised for the resident who has epilepsy so that staff are aware of the necessary action to take should the resident suffer an epileptic attack. A risk assessment should also be carried out so as to ensure that possible risks are identified, minimised and managed. Hand wash basin should be provided in the laundry so that staff are able to wash their hands and control the spread of infection. The salt dispenser for the dishwasher in the main kitchen is very corroded and should be repaired or replaced to enable thedishwasher to wash the dishes and utensil effectively. Fire drills carried out should also be planned and include the night staff so that they are kept up to date with fire safety practices to ensure that all people using the service are kept safe. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingfisher Nursing Home Emmanuel Lodge College Road Cheshunt Hertfordshire EN8 9NQ     The quality rating for this care home is:   two star good 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: Bijayraj Ramkhelawon     Date: 2 7 0 5 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 25 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 25 Information about the care home Name of care home: Address: Kingfisher Nursing Home College Road Emmanuel Lodge Cheshunt Hertfordshire EN8 9NQ 01992627939 01992632708 kingfisher@westgatehealthcare.co.uk 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) : Westgate Healthcare Limited care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Additional conditions: 0 This home may accommodate 22 older people in need of convalescent care (aged above 55 years). This home may accommodate 22 older people in need of general nursing care. Date of last inspection Brief description of the care home Kingfisher is a care home providing nursing and convalescent care for 22 older people. The home is privately owned and situated on the ground floor of Emmanuel Lodge, a two-storey complex, which provides supported housing for older people. Emmanuel Lodge is jointly owned by Broxbourne Borough Council and a Primary Care Trust. Kingfisher has eighteen single and two double bedrooms. None of the bedrooms have en-suite facilities. There is level access suitable for wheelchairs throughout the home and lounge and conservatory areas for the benefit of service users. The home has its own laundry but kitchen facilities are shared with Emmanuel Lodge. Service users have access to the gardens and patio belonging to Emmanuel Lodge and there are extensive areas for parking around the home. The building is situated in an area of parkland on the outskirts of Cheshunt, where there are shops, pubs and bus services. The A 10 Care Homes for Older People Page 4 of 25 Brief description of the care home trunk road, the M 25 motorway and rail links are nearby. Prospective service users are provided with information about the home, in the form of a Service Users Guide. Copies of this document and the homes Statement of Purpose are also displayed centrally in the home. Current fees charged for the home range from £578 to £800 per week (as at 24/04/09). A copy of the Statement of Purpose and the Service Users Guide and the last inspection report can be obtained from the care home on request. Care Homes for Older People Page 5 of 25 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: two star good 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: This unannounced key inspection was carried out on the 24th April 2009 and took one whole day. It included talking to people using the service, staff and visitors, examining care plans, medicine records, staff files, staff training records, fire safety procedures, maintenance records, all other records and documents and a tour of the premises. The home has completed an Annual Quality Assurance Assessment (AQAA) and information from this assessment has been reflected in this report. 12 completed questionnaire surveys were received from the residents, 15 from care staff and one from a visiting professional. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: Care plans for pressure ulcers should include the type of pressure relieving mattresses or other equipment provided and the advice from the Tissue Viability Nurse sought. A specific care plan should be devised for the resident who has epilepsy so that staff are aware of the necessary action to take should the resident suffer an epileptic attack. A risk assessment should also be carried out so as to ensure that possible risks are identified, minimised and managed. Hand wash basin should be provided in the laundry so that staff are able to wash their hands and control the spread of infection. The salt dispenser for the dishwasher in the main kitchen is very corroded and should be repaired or replaced to enable the Care Homes for Older People Page 8 of 25 dishwasher to wash the dishes and utensil effectively. Fire drills carried out should also be planned and include the night staff so that they are kept up to date with fire safety practices to ensure that all people using the service are kept safe. 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. 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 25 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 25 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 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 information about the home to assist them in making informed choices. They know that their needs would be assessed before moving into the home which helps ensure that the home can meet their needs. Evidence: The current Statement of Purpose and Service Users Guide are comprehensive, are displayed in the home and are provided to all residents and families. The manager has provided the commission with an up to date copies of both documents. An assessment of needs for each individual was carried out prior to admission and residents spoken to said that they were able to visit the home before making a decision to move in. Information taken from the AQAA, the registered manager has stated that within the Care Homes for Older People Page 11 of 25 Evidence: next twelve months the pre-admission assessment form will be reviewed to include other additional information required to meet the needs of people chosing to use the service. Care Homes for Older People Page 12 of 25 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 living in the home can be sure that their identified needs would be met appropriately and that medication practices were robust to protect and safeguard them. Evidence: Four care plans were examined these were comprehensive, detailed and person centred. A wide variety of risk assessments including manual handling, Waterlow chart, nutritional assessment had been completed and been regularly reviewed. Records showed that pressure area care were being monitored, evaluated and assessed on a regular basis. However, the care plan for one resident who has pressure ulcer did not indicate which type of pressure relieving mattress or other equipment were used and that whether the advice of the Tissue viability Nurse has been thought. A specific care plan should be devised for the resident who has epilepsy so that staff are aware of the necessary action to take should the resident suffer an epileptic attack. A risk assessment should also be carried out so as to ensure that possible risks are identified, minimised and managed. Residents spoken to said that they were being Care Homes for Older People Page 13 of 25 Evidence: well looked after and that they felt that their needs were being met in a professional way and staff respected their privacy and dignity. The records for the administration and management of medicines were kept in good order. The medicine record charts showed that medicines were given as prescribed and unused medication was returned to the supplying pharmacy. A monthly audit of the system including the ordering, storage, administration and disposal of medicines was carried out. Information taken from the AQAA, the registered manager has stated that within the next twelve months training will be provided for staff so that they will be aware of the implications of the Mental Capacity Act and Deprivation of Liberty. Additional new profiling beds will be purchased to ensure that people have the right equipment to meet their needs. Care Homes for Older People Page 14 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can benefit from the opportunities to participate in activities that are appropriate to their needs and ensure that they enjoy their daily lives and remain part of the community. Nutritious meals are provided in a way that residents can enjoy and this promotes individual good health. Evidence: A dedicated activity co-ordinator plans the activities on a weekly and seasonal basis, a programme of which was prominently displayed. Residents spoken to said that there are a variety of excellent activities provided for them and that they are able to chose which one to join in. On the day of the inspection an entertainer was singing and playing the guitar to which residents was listening and some were singing along. Each resident has a book identified as my memory book that included their favourites such as actors, footballers, games etc. Residents also said that the activity co-ordinator and the care staff provided one-to-one discussion and support for those who do not wish to join in with a group. Trips out takes place on a regular basis and residents said that information about the local community was available to them and are able to visit local places of interests. The home has no transport and the co-ordinator organises local specialised transport for some of the more distant trips. The co-ordinator completes Care Homes for Older People Page 15 of 25 Evidence: records detailing individual preferences and histories and keeps information about who attends each event. The local Chaplin visits the home once a month for mass ceremony. Visitors spoken with said they were always welcomed in the home, at all times and were provided with refreshments by the staff. Details of advocacy services were displayed in the main area of the corridor. Care staff provide breakfast and tea meals for residents but the main meal is provided by the shared kitchen staff in Emmanuel Lodge. There is a choice of two main meals and these choices were displayed in the dining room. Residents spoken with said they enjoyed the food in the home and the meal served during the visit looked nutritious and appetising. Lunch was unhurried and drinks and condiments were provided on tables. Residents who required assistance with their food, were supported in a discreet and sensitive way. Information taken from the AQAA, the registered manager has stated that within the next twelve months the home will explore the use of Independent Mental Capacity Advocates to support people using the service. Care Homes for Older People Page 16 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their concerns would be listened to and acted upon and that they would be safeguarded from abuse, neglect and harm Evidence: The home has written policies on Complaints, Safeguarding Adults and Whistle Blowing which staff said they were aware of. The complaints procedure is also included in the Service Users Guide. Residents spoken to said they would not hesitate to voice a concern if they had one. Suggestions and complaints forms are available to people using the service and their relatives. No complaints have been received in the last twelve months. All staff members have training in Safe guarding Adults, both at induction and later in more detail. Staff are aware of the Hertfordshire Local Authority and National procedures for dealing with any adult abuse concerns. Care Homes for Older People Page 17 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are cared for in an environment that is homely, comfortable and safe which meet their needs. Evidence: The home was kept clean, fresh and pleasant. Nine of the residents bedrooms have been fitted with new carpet. Residents spoken to said that the home was always kept clean and bedrooms were well furnished and generally spacious. It is comfortable and homely. They also said that they were happy with their bedrooms and that they are able to bring their personal possessions and belongings. Staff spoken to said that they had undertaken training in infection control and it was noted that alcohol gel was available in the corridors at strategic places to help with hand hygiene. Protective clothes and gloves and hand washing facilities were provided. However, it was noted that the laundry room did not have a hand washing basin which leaves a risk for increasing infection when handling soiled laundry. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service do benefit from the care and support they receive from a competent and qualified staff team and that they feel protected by the homes recruitment policies and procedures. Evidence: Residents and staff spoken to felt that, generally, there were adequate numbers of staff working in the home. Six staff files were examined and these were found to have all the necessary documents including two written references for each employee and the Criminal Records Bureau (CRB) checks were carried out before an offer of employment was made so that residents would be safe and protected. New staff undergo a programme of induction and staff are provided with training relevant to their work. Staff spoken to confirmed that that they received formal supervision on a regular basis. They also said that they received support from senior members of staff and the management team was approachable and helpful. Staff were knowledgeable about the needs of residents and provided support in a sensitive and professional manner. Residents and relatives spoken to said that there was a good staff team working in the home and that the balance of nursing, care and domestic staff was working well. Residents also said that call alarms were answered in good time and that care staff did Care Homes for Older People Page 19 of 25 Evidence: not rush their personal care. All staff have completed basic training courses and more updates have been planned by the manager. Staff are encouraged to undertake NVQ training and at present, there are 8 care staff in post of whom 3 have completed the NVQ Level 3. Currently, 2 staff are undertaking the Level 2 and one Level 3. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their health, safety and welfare are protected by the safe practices in place and the support they receive from an open and transparent management team. Evidence: People using the service have commented positively on the good practices and quality of care and support they received. Staff, residents and relatives spoken to praised the manager and said on how efficiently the home was run. They also said that the manager was approachable and supportive. Minutes are kept of both staff and residents meetings and outcomes from these are included in Quality Assurance monitoring. There is an established system of Quality Assurance in the home and the manager monitors all the information from this and gives feedback to residents and families. A summary of outcomes and planning was on display in the home, as it was at previous visits. Care Homes for Older People Page 21 of 25 Evidence: The financial records of two residents were tracked with the homes administrator and all records were in order, with receipts in place for all amounts spent on behalf of the residents. These records are also kept electronically. Records of fire alarm checks and fire drills were maintained on a regular basis. However, it was noted that a fire drills have not been carried for night staff. It was also noted that the salt dispenser for the dishwasher in the main kitchen was corroded and should be repaired or replaced.There are a variety of risk assessments completed for the building and grounds and these are regularly reviewed. The recliner chairs in the home also have individual risk assessments completed. Records were available for inspection and maintained in accordance with legislation to ensure that the safety of people in the home is promoted. Records examined were up to date and accurate and were held securely. Staff spoken to were aware that people using the service can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures to ensure that the health, safety and welfare of residents and staff are promoted and protected. A valid insurance certificate was displayed and expires in September 2009 Care Homes for Older People Page 22 of 25 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 23 of 25 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 8 Care plans for pressure ulcers should include the type of pressure relieving mattresses or other equipment provided and the advice from the Tissue Viability Nurse sought. A specific care plan should be devised for the resident who has epilepsy so that staff are aware of the necessary action to take should the resident suffer an epileptic attack. A risk assessment should also be carried out so as to ensure that possible risks are identified, minimised and managed. Hand wash basin should be provided in the laundry so that staff are able to wash their hands and control the spread of infection. The salt dispenser for the dishwasher in the main kitchen should be repaired or replaced as it was very corroded. Fire drills carried out should also be planned and include the night staff so that they are kept up to date with fire safety practices. 2 8 3 26 4 5 38 38 Care Homes for Older People Page 24 of 25 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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