Care Home: Kingsley Nursing and Residential Centre

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What the care home does well People live in clean, warm, pleasant surroundings, and equipment is provided to make sure they remain comfortable, and receive care in a safe way.People`s care plans describe their care in a personal way, which means that one care plan is very different to the next, and relates to their personal needs and wishes. Staff treat people with respect and dignity. People enjoy a happy good humoured atmosphere which is relaxed and friendly. People have a range of activities they can attend, and these are being regularly reviewed to make sure they meet people`s needs. People can also maintain important links with their family and friends, and can continue to worship so that their spiritual needs are met. People enjoy a good diet, which is checked regularly to make sure it is nutritious. They can make suggestions about what they would like to see on the menu, and their choices are listened to and put into practice. The home is being run by an acting manager whose priority is to provide consistent care to people by staff who know them. There are systems to check that people are happy with the service they get, and action is taken to make changes where they are not. What has improved since the last inspection? People who want to look after their own medication are now assessed to check that it is safe and practical for them to do so. Information is passed onto the chef when people have special dietary needs. This means that they can be assured that they will receive the right diet to meet their needs and preferences. Staff know who they must go to in an emergency which needs first aid attention, and there is always someone available who is qualified to give this care. Staff sit with people when they have their meals. This makes the occasion more social and enjoyable for all concerned. People now have access to their persona allowance kept by the home at the weekend as well as during the week. This means that they can ask for money at any time, to spend as they wish. What the care home could do better: More information could be gathered about people before they are admitted so that a more informed decision can be made about whether the home has the resources to meet their needs successfully. Once admitted, people`s needs assessment could be reviewed more regularly as intended. This would help staff to reflect better on all areas of care, andhow one change in need may affect another. As people`s needs change, risk assessments which consider safe care, risks to people`s health and welfare, and use of equipment, and how it is to be provided consistently, could always be completed and kept up to date. Improvements could be made to some of the ways that medication is handled and stored by staff, to ensure the systems are safe, and medication remains fit for use. Staff could be reminded of the crucial role they play in alerting the right people when they suspect that someone living at the home has not been treated as they should be, so they all, without fail, take the right action quickly. And the recruitment procedures could be improved to reduce the risk from unsuitable workers being allowed to work with people living at Kingsley. Staffing levels should be closely monitored to make sure people are receiving a consistent, well managed service. This will provide the acting manager with the support she needs to keep up to date with her management role, whist maintaining good care standards, so she is able to manage the home successfully in the best interests of those who live there. CARE HOMES FOR OLDER PEOPLE Kingsley Nursing and Residential Centre 36-40 Ripon Road Harrogate North Yorkshire HG1 2JJ Lead Inspector Anne Prankitt Key Unannounced Inspection 19th February 2009 9:30am 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 Kingsley Nursing and Residential Centre DS0000069199.V374270.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. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsley Nursing and Residential Centre Address 36-40 Ripon Road Harrogate North Yorkshire HG1 2JJ 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) 01423 560689 01423 521290 holmessa@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 years plus. Date of last inspection 12th March 2008 Brief Description of the Service: The home is owned by BUPA Care Homes. It is situated on a busy road within walking distance to the centre of Harrogate. There is a small garden area to the front of the building, and limited parking facilities to the rear. The accommodation is provided over three floors, which are accessed by passenger or stair lift. The home provides nursing care or personal care only for up to 43 older people. The acting manager confirmed on the day of the site visit that the current range of weekly fees was £450- £600. The registered nursing care contribution is calculated separately, where applicable. Additional charges are made for hairdressing, chiropody, papers/magazines, clothes labels, taxi fares, nail technician attention and toiletries. People who are considering living at the home are given a copy of the home’s brochure before they are admitted, so that they have information about what services the home provides. They are also given some financial information. Once admitted, people are given a copy of the service users’ guide. The inspection report is kept at the reception area, and the manager will give people a copy at their request. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the acting manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Completed comment cards from some people living at the home, some staff who look after them, and some health professionals who visit the home. A site visit to the home by one inspector. The visit lasted for eight hours over one day. During the visit, several people who live there, some staff, and the acting manager were spoken with. Three people’s care plans were looked at in detail, and one in less detail, as well as some staff records, and some information which shows how the home is kept safe and maintained. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at Kingsley. The acting manager was available throughout the day, and was provided with feedback at the end. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only where it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People live in clean, warm, pleasant surroundings, and equipment is provided to make sure they remain comfortable, and receive care in a safe way. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 6 People’s care plans describe their care in a personal way, which means that one care plan is very different to the next, and relates to their personal needs and wishes. Staff treat people with respect and dignity. People enjoy a happy good humoured atmosphere which is relaxed and friendly. People have a range of activities they can attend, and these are being regularly reviewed to make sure they meet people’s needs. People can also maintain important links with their family and friends, and can continue to worship so that their spiritual needs are met. People enjoy a good diet, which is checked regularly to make sure it is nutritious. They can make suggestions about what they would like to see on the menu, and their choices are listened to and put into practice. The home is being run by an acting manager whose priority is to provide consistent care to people by staff who know them. There are systems to check that people are happy with the service they get, and action is taken to make changes where they are not. What has improved since the last inspection? What they could do better: More information could be gathered about people before they are admitted so that a more informed decision can be made about whether the home has the resources to meet their needs successfully. Once admitted, people’s needs assessment could be reviewed more regularly as intended. This would help staff to reflect better on all areas of care, and Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 7 how one change in need may affect another. As people’s needs change, risk assessments which consider safe care, risks to people’s health and welfare, and use of equipment, and how it is to be provided consistently, could always be completed and kept up to date. Improvements could be made to some of the ways that medication is handled and stored by staff, to ensure the systems are safe, and medication remains fit for use. Staff could be reminded of the crucial role they play in alerting the right people when they suspect that someone living at the home has not been treated as they should be, so they all, without fail, take the right action quickly. And the recruitment procedures could be improved to reduce the risk from unsuitable workers being allowed to work with people living at Kingsley. Staffing levels should be closely monitored to make sure people are receiving a consistent, well managed service. This will provide the acting manager with the support she needs to keep up to date with her management role, whist maintaining good care standards, so she is able to manage the home successfully in the best interests of those who live there. 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. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience adequate outcomes in this area. More information could be collected before people are admitted so they can be assured that a thorough judgement has been made their needs will be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: When people make an enquiry about the home, they are given a brochure telling them what the home provides. This includes pictures of the building, so people can get a feel about what it looks like if they are unable to visit personally. However, they are encouraged to visit if they are able. Two pre admission assessments were looked at. A staff member from the home had assessed each person before they were admitted, but this had been done on the day of the admission, which does not give a lot of time for the person’s needs to be considered. In both cases, the care management care plan had not been requested and obtained before the admission was agreed Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 10 and took place. And in one case, information about the person’s care had not been sought from the service where they currently received care. In both admissions, therefore, there was a lot of information that could have been obtained but which was not, when deciding whether Kingsley could provide the care and support needed for each individual. This does increase the chance of admissions going wrong. Out of the seven people who returned their surveys, one person thought they didn’ t get enough information about the home before they moved in, and one did not know. However, five people said they did. One of these said ‘the home came up to my expectations in every way’. The last report recommended that people should be given the option of seeing their contractual arrangements, because this keeps them more closely informed about their rights and obligations. Four out of seven people who returned their surveys told us they had received a contract. One said they had not, and two did not know whether they had received one or not. The administrator said that people are not precluded from seeing this. However, the administrator thought that sometimes the family assumed that it was their role to deal with this part of the admission. The home should continue to offer people the opportunity to see their contract, therefore this recommendation should be kept under consideration as each person is admitted. Intermediate care is not provided at the home. Therefore Standard 6 is not applicable. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 11 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): 7,8,9 and 10 People who use the service experience good outcomes in this area. Their care needs are generally met, but staff could improve the way they write down how they manage risks to people, so they work consistently. And improvements could be made to the way the medication systems are audited to pick up errors more quickly. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There is a set care plan format provided which leads staff to think in a person centred way, and to consider any risks to people’s well being. One staff member said that they ‘couldn’t get through the day without them’. Other staff had more mixed views about whether they get enough up to date information about the needs of people. Two of these said that the way information is passed on ‘usually’ works well, while two said this is ‘sometimes’ the case. People have a thorough assessment when they arrive. A care plan and risk assessment is developed from this wherever a need is identified. Generally, Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 12 the information seen in the care plans reflected people’s overall needs in an individual way, and there was some good information about individual choices and preferences. All of the information was considered in the monthly review of each separate care plan in people’s files, although sometimes the main needs assessment was not re visited within the expected timescales. Without this thorough overall assessment, it does make it more difficult to decide whether any further assessment of risk or additional care plans are needed. This in turn increases the chance of important information being ‘forgotten’ or ‘missed’. For instance: • Recent behaviour displayed by one person had been looked into, but no risk assessment or care plan had been developed to support the person and to show staff how to work in a consistent way to best meet the person’s overall needs. Another person had moved rooms and had been given a bed which helped to meet their needs better. However, the decision to use bed rails had not triggered a risk assessment before they were used. The care plan told us the person had problems with maintaining good nutrition. Although action had been taken to address this, they had not been weighed since they arrived. However, the acting manager said that this person’s nutrition was being closely monitored. The chef also confirmed that the person could have what they want to eat, whenever they wanted it. This must be kept under close review. It was not clear from the records what action had been taken to address the weight loss of another person following consultation with their doctor, although the acting manager knew what advice had been given. Since the site visit we have been told that the person’s nutritional needs, and how they are being met, are now recorded clearly, and in line with up to date advice from their doctor who is monitoring the situation. • • The acting manager has now amended all of these care plans. This is of particular importance at the moment where the home, on occasions, is having to use bank staff, who may not know people, and who will rely on good care records being kept. However, there was lots of written evidence to show that the staff do get professionals to visit when things go wrong with people’s care, or where they need more advice. Staff have also forged close links with the community matron, who visit the home regularly to give valuable support and advice around people’s nursing care needs. People who returned their surveys all agreed that staff listen and act on what they say, and that they ‘always’ or usually’ get the care and support they need. One person went on to say ‘and am greeted in the morning and during the day with great respect’. They continued ‘I am very happy and contented here’. On the day of the site visit, people were spoken to with respect, and their right to privacy was acknowledged. There was lots of laughter and the atmosphere was very relaxed. One person said ‘It’s lovely here – a lovely atmosphere – we’re all very happy, but you can probably tell already’. Another Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 13 said that ‘Staff give good care’. People cared for in their rooms looked comfortable. Staff had taken the time to explain to one person having a period of bed rest the reasons why this was necessary. This attitude helps to keep people involved and informed about their care, which is good. Staff normally look after people’s medication on their behalf. A risk assessment is shared with, and agreed by, the person’s doctor, before they are given responsibility for their medication. We were told that people have locked facilities to store their medication safely. Medication managed by staff is stored in two areas, depending upon which part of the home the person lives. It is safely locked away. The staff count and sign to show how much medication arrives at from the chemist so they have a good running record to refer to. The acting manager said that the area manager does a monthly check to make sure the medication is being managed safely. In addition, the acting manager also does a small audit. This has been more difficult to carry out because of staffing pressures, which means she has had to spend more time delivering care than managing the home. One of the nursing staff said they and their colleagues have assumed the collective responsibility for keeping the medication in good order in the meantime. However, there were some shortfalls which had been overlooked, and which may have been picked up if the audit was more thorough: • • • The medication room temperature was sometimes too hot for storage purposes, sometimes measuring 30 degrees centigrade. This needs to be put right to make sure that medication remain in good condition for use. One liquid medication had not been marked clearly to explain when it should be disposed of. Staff need to make this clear so the medication people get is fit for use. One person had ran out of their medication for two days. It was accepted that this was because a check had not been kept on the remaining stock by staff, and whether it was necessary to re order. This had already been sorted out, but staff need to remain vigilant so people get the medication they are prescribed. Some eye drops which need to be kept refrigerated were being stored at room temperature. This could mean that they do not work as they are intended. The nurse was asked to check the stock and put right any such errors. Hand written records by staff were not always countersigned as being correct. This should always be done as it reduces the risk from incorrect instructions being written down. • • Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 14 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): 12,13,14 and 15 People who use the service experience good outcomes in this area. People are offered a range of activities to meet their interests, and can maintain links with family and friends who are important to them. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People get a range of activities to help meet their needs. Group activities and forthcoming events were advertised in the main hallway for people to see. There were photographs of past events, which people had enjoyed, such as a planned event involving the local fire brigade, when people and staff practiced the fire procedure, and tried out new equipment provided for easy evacuation. This makes learning about such matters more memorable. On the day of the site visit, people were included in board games, quizzes, and discussions around magazine articles read to them. People really enjoyed these activities, and there was lots of conversation and laughter from those who joined in. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 15 The activities organiser has her own file, from which information is passed on periodically to the staff so they can add it to people’s care plans. She has also completed life histories with people and their families, so staff can understand more about people, and what interested them, in the past. She also knew how much input people who stay in their rooms enjoyed. Some have regular visitors, so are busy without the needs for additional activities. She makes a point of seeing others who spend more time on their own more regularly, so they get some social stimulation. In addition to this, and to assist in meeting people’s spiritual needs, representatives from different denominations visit the home. A monthly communion service takes place, and one to one weekly visits have just been organised for someone who expressed a wish to have these. This shows that people’s individual needs are being thought about. People can have visitors whenever they want, and can see them in their own room or in the communal areas. Relatives and residents meetings are held where people discuss things like forthcoming social events, and the menu. Changes are made based on their views. People said they could make their own decisions about what they do, and when. For instance when they get up and go to bed, what activities they join, and where they eat. This shows that staff are being flexible and are listening to people’s preferences. One person said they could ‘chose to stay in bed’ if they wanted. They said the visiting was ‘flexible’ which they appreciated. Four of those who returned their survey said there were always activities for them to join. Two said this was usually the case, whilst one said sometimes. The menu has to pass certain standards set by the company before it can be used. The chef said, however, that changes are sometimes made to the menu to meet people’s wishes. For instance, at the last residents’ meeting, various alternatives were put forward by people and their families. These meals were currently being ‘trialled’ by people to see how popular they are. People get a choice of menu at each mealtime. There are three meals each day plus a light supper. People are offered drinks and snacks between meals. Cold drinks were available in the communal areas throughout the day, so staff could replenish people’s glasses and cups when necessary. When people cannot decide what they want for their meal, enough is prepared so they don’t have to make a decision until the meal is served. Six out of seven people who returned their surveys said they always like the food. One added ‘I cannot speak highly enough of the variety of the food’. One person said they usually liked the meals. On the day, people made comments like ‘The food is lovely – I had lamb today – it was nice’, ‘The food’s nice’. The chef asks Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 16 people after their meal if they have enjoyed it. This allows him to make adjustments to the menu depending upon the feedback he gets. The chef has a budget which he states is sufficient to provide people with well balanced meals. Fresh meat, vegetables and fruit are delivered to the home four times each week. People also enjoy home baked cakes made on the premises. Special diets are catered for, and the catering staff are provided with details about this so they give people the correct diet. Although the chef knew about the dietary needs of one such person, the acting manager said she would make sure that this information was added to the records kept by the chef, because this had been overlooked. The mealtime was relaxed and calm. People seemed to enjoy their meal which looked nice and hot. Staff sat with people who needed help, and made sure they were not rushed, so they had time to enjoy it. People who needed to have their meal liquidised had this served in separate portions. One staff member took the time to explain each component of the meal to the person. This helped them to enjoy the various textures and tastes. People were provided with special equipment to help them to enjoy their meal independently. However, staff must make sure that plate guards are used correctly to stop food from dropping from the plate onto people’s clothing. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 17 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): 16 and 18 People who use the service experience good outcomes in this area. Complaints and allegations brought to the company’s attention are taken seriously and acted upon. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the hallway of the home so everyone passing can see it. People also get a copy of the procedure when they are given their service users’ guide on admission. Everyone who returned their surveys agreed they know how to complain. Six of these said they know who to talk to if they are not happy. The seventh said they usually are. However, they continued ‘But so far no complaints’. Those on the day made comments like ‘(The acting manager) is about a lot. I would complain to her if I had any problems’, and ‘I think (the acting manager) would sort things if anything was wrong’. There were no complaints recorded in the home’s complaints records. However, there were two complaints recorded in a person’s file. Although the acting manager was able to tell us what she had done to put these right, the information had not been recorded in the complaints record, and the outcome of the complaint, and whether the person making it was satisfied, was not clear. This makes it more difficult for the area manager to provide support and Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 18 guidance during their audit of the home, because they may not know that a complaint has been made. It also makes reviewing the quality of the service with regards to response to complaints more complicated when information is not readily available. One concern about staffing levels was made direct to the Commission for Social Care Inspection. The home was asked straight away to provide more information so we could be sure there were enough staff to care for the people living there. The acting manager told us what she had done to restore and maintain the staffing levels. It was deemed by the commission that her action was appropriate at the time. The home has passed on information correctly to social services and the Commission for Social Care Inspection about four issues which they recognised as safeguarding alerts, and where they identified vulnerable people living at the home may be at risk. In each completed case they have taken the right action to keep people safe both during and following the investigation. We have been given assurance that we will receive feedback regarding any further action to be taken by the company about one investigation which had just been completed. Those staff spoken with on the day were clear about their responsibilities in the prompt reporting of both complaints and concerns. They knew they could not keep secrets, and they knew who to tell, if they suspected people were being mistreated. This helps to keep people safe. However, the acting manager has identified that there was a delay in her receiving some information which could have impacted on people’s welfare. Although this has been dealt with, she must make sure that she stresses with staff the importance of reporting any incident quickly, so the right action can be taken to protect people immediately. She plans to give staff further supervision about safeguarding and whistle blowing to make sure they are fully aware of the seriousness of their responsibilities in reporting. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 19 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): 19 and 26 People who use the service experience good outcomes in this area. People live in a warm comfortable environment which is kept maintained. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The environment was clean, warm and comfortable. People who returned their survey said that the home is ‘always’ or ‘usually’ kept fresh and clean. It is situated on a main road leading out of Harrogate town centre. There are three sitting areas for people to choose from. One of these is a light and airy conservatory, which overlooks the main road. Another has only recently been created, to provide another television area after people requested this. There are two pleasant dining areas where people can eat if they want to. The accommodation is provided over three floors. There are some steep ramps and narrow corridors in some areas on the first and second floors. This is quite Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 20 challenging for staff when transporting hoists around the building. It also means they have to be very careful when moving people in wheelchairs. It is important that the layout of the building is considered when deciding whether the home would be suitable for people before they are admitted, so that their ability to get about independently is not compromised by the challenges of the building. All areas of the home were clean and tidy. People’s rooms were individual to them, and contained their personal belongings. This helps to make the rooms feel more familiar for people. The laundry is in the basement. The washing facilities are appropriate. Staff are provided with protective clothing to help them work in a safe way, and to reduce the risk from cross infection. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 21 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): 27,28,29 and 30 People who use the service experience adequate outcomes in this area. People are cared for by staff whose numbers may fluctuate, but who get training to keep their practice safe and up to date. More care could be taken when new staff are recruited to work in an environment where vulnerable people live. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: When asked in their survey if staff are available when needed, four people said ‘always’, two said ‘usually’, and one said ‘sometimes’. Comments on the day included ‘It’s OK here. The staff give good care. There are usually enough staff. The only time the home is short staffed is when they go off sick at short notice’, ‘The care is fine. The girls are good. I press the bell and they come’. Staff surveys reported that three think there are ‘sometimes’ enough staff to meet people’s needs. One chose not to answer this question. One staff member commented that more thought could be given when employing new staff, ‘not just taking anybody on so the staffing levels are OK’. Another comment was made that ‘Hopefully things will start to improve and advertising for bank staff would be a good idea’. One staff member on the day said that levels were maintained because of the acting manager’s flexible Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 22 accommodating approach, which meant that staff were more willing and able to provide cover when levels were short. In addition, a concern was raised with the commission about perceived staff shortages at the home, as stated in ‘Complaints and Protection’. The acting manager said that staff numbers can fluctuate, and that maintaining staff levels has been a big challenge for her. She makes sure that no less than five staff are available during the day to provide people with their care. This is based on a current occupancy of twenty eight. A minimum of four staff are available at night. The acting manager said that it is often the number of trained staff on duty that is affected most, as the home has great difficulty in recruiting trained nurses in a timely period. At the time of the site visit the home was ninety six hours short of trained staff hours from that which is recommended by the company. This means that the acting manager has sometimes had to work ‘hands on’, rather than concentrate on her management duties. As a last resort she uses agency staff, or bank staff from other homes owned by the company. But she does try to keep this to a minimum so that she can be assured that wherever possible, people are not cared for by staff who are strangers to them. The number of nurse hours will be improved once the acting manager returns to her post of senior sister when the new manager takes up post. And the company is attempting to recruit into these vacant posts. However, this situation needs to be kept under review. All four staff surveys agreed that these staff were receiving training which was relevant to their job. One commented that the home ‘supports staff with training to ensure good standards of care’. They said the home ‘puts the service user at the centre of everything’. There is a rolling programme of training in place for staff to undertake in addition to that which by law they have to complete. For instance, staff are encouraged to work towards National Vocational Qualifications in Care. The acting manager said that some staff were reluctant to complete this award. They should be encouraged to do so, so that people can be assured they will get good, consistent care from a well qualified work force. All staff complete training called ‘Personal Best’. We were told this teaches staff about good customer care, dignity and respect and equality and diversity, although one staff member felt they did not get training to help them to understand the latter. Trained nurses also get opportunities to update their skills. The staff training matrix was out of date, and the acting manager was in the process of transferring information from individual files onto this matrix so she can see at a glance where training needs to be updated. She is certain, with the plans she already has in place, that all staff will be updated by the end of the month. Supervision has fallen behind. The acting manager was aware of this, and has been trying hard to find time to get this back on track. This will Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 23 be of benefit to staff, who will all be receiving planned supervision in the near future about recognising and reporting abuse, and the home’s whistle blowing policy. Two staff recruitment records were looked at. One staff member had begun to provide care before their full police check had been returned, but after a check had been made to make sure they were not barred from providing care. The acting manager gave assurance that this person was supervised at all times until the full check was returned. However this was not recorded anywhere, but should be, so staff are clear on each shift when they are responsible for supervision of another member of staff. There were also gaps in this person’s employment history, which had not been explored. Their induction was not available, because staff keep their training pack with them whilst they are completing it. However, the staff who returned their surveys agreed that their induction ‘mostly’ covered what they needed to know about their job. The second file seen again showed that gaps in this person’s employment had not been explored. And ‘to whom it may concern’ references had been accepted. This is not best practice. Accepting references in this way means that the home cannot guarantee that the reference is from the previous employer, who in turn has not had the opportunity to give their views about the person’s suitability to work in an environment where vulnerable people live. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 24 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): 31,33,35 and 38 People who use the service experience good outcomes in this area. The home is managed by an acting manager who always tries to run the home in people’s best interests, but who needs enough time and resources to do so properly. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The previous registered manager no longer works at the home, which is being run by an acting manager until the new manager takes up post at the end of March. She said this role had not always been straightforward, partly due to difficulties in recruiting good trained nurses, which has meant that she has spent less time completing managerial duties than she would have liked, because she has often been needed ‘on the floor’, working as a nurse Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 25 providing ‘hands on’ care. Neither has she been able to attend any management training offered to her, because she states her priority has been to continue to provide consistent care for people, with the limited staffing resources she has had available. The acting manager is aware that this situation has meant that some of the management systems previously in place have fallen behind, but was very clear that her priorities were always to make sure that the people living at Kingsley continued to receive good care from people they know. Staff are very supportive of the acting manager. One said the home has ‘been through a bad patch and all staff feel that too much has been expected of the them. They said that (the acting manager) has been doing her best.’ Another described the acting manager as ‘great’. They said ‘she has a passion for her job and she respects other people’s roles’. A health professional commented that although people’s care had not been affected, communication between staff had not always been as effective under the current arrangements whereby the acting manager was not ‘on the floor’ as regularly as before in her previous role as senior sister, because of her additional managerial duties. The acting manager is now trying hard to get everything back up to speed before she hands over her responsibilities to the new manager. There is also a new area manager in post since the last inspection. He carries out regular visits, which include audits to check each department is working smoothly, and in line with company policy. He writes an action plan following these visits for the acting manager to follow. The acting manager said that he supports her in her role as manager. There is also a department which oversees, measures, and gives advice about the quality of the service that people living at the home get. Surveys are sent to people and their families each year. The acting manager did not think visiting professionals were surveyed. It is good practice to do so however. The results were not yet back from the most recent survey. The acting manager was waiting for these to be returned so she could see people’s collective views about how the home was running, and where they would like to see changes. People have their personal allowance looked after by the home if this is their choice. This money is banked on their behalf in a pooled account which accrues interest. This interest is shared amongst people depending upon how much they have saved. Records are kept up to date so people can see how much money they have saved. Systems are now in place so they can have access to their money at the weekend as well as during the week in case they should need it unexpectedly. People who want to manage their own money are be supported to do so, and provided with locked facilities to keep it safe. The maintenance man keeps track of in house checks, such as the weekly fire alarm checks, making sure that hot water is maintained at a safe temperature, Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 26 and making sure that bed rails are maintained in safe working order. He also keeps track of when major appliances are due for their periodic checks. This helps to keep the premises safe for people. It was not clear whether one issue raised in the last check of the gas appliances had been addressed. We have since been told that the maintenance man is dealing with this, but reassurance has been given that the current arrangements are safe for people. Two of the sluice rooms had been left open by staff, despite clear instructions on the door that they must be kept locked. The acting manager rectified this straight away. Staff must be reminded of the unnecessary risks this poses to people and must always keep the room locked when not in use. Staff undertake a range of training so they know how to work in a safe and lawful way. This includes training in moving and handling, fire safety, infection control and food hygiene. There is always a first aid qualified person on duty. The details of who this person is are displayed in prominent places around the home so staff can see at a glance who they should go to in an emergency. The acting manager said that she no longer has an in house moving and handling trainer, so is having to make arrangements with other homes in the area owned by the company to make sure this training does not fall behind. However, on the day, staff were observed using the moving and handling equipment safely, and the people who were being moved looked comfortable and safe when they were assisted. The Environmental Health Officer has made a routine inspection of the kitchen area since the last key inspection. We were told that overall they were satisfied with the systems in place. Matters which needed attention have been seen to, or are being looked at by the company, such as some work needed to the staff area, which is not accessible to people living at the home. On the day of this inspection, it was noted that on the previous day, required records to show that, for instance, food had been served at safe temperatures, had not been recorded. This was brought to the attention of the chef, as the records are normally completed properly. He intends to follow this up to see why they were not made in his absence so it does not happen again. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 27 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 19/02/09 2 OP7 13 3 OP9 13 As stated at the site visit, all available assessment information must collected before a decision is made as to whether a person’s needs can be met by the home. This will reduce the chance of inappropriate admissions being made. As people’s needs change, risk 19/02/09 assessments which consider safe care, risks to people’s health and welfare, and use of equipment, and how it is to be provided consistently, must always be completed and kept up to date. The storage, record keeping, 31/03/09 stock control and auditing of medication must be reviewed and improved to make sure that the systems remain safe, and action must be taken where shortfalls are identified. This will satisfy that the system maintains the quality of the medication, that people are not at risk, that they get the medication they are prescribed, and that medication is stored at the right temperature. DS0000069199.V374270.R01.S.doc Version 5.2 Kingsley Nursing and Residential Centre Page 29 4 OP18 13 5 OP29 19 It must be further stressed to 31/03/09 staff about the importance of reporting their concerns about potential abuse quickly, so any matters can be dealt with immediately and the correct action taken to keep people safe. 19/02/09 Thorough recruitment practice must be maintained. This includes: Obtaining two written references, one from the person’s previous employer, before staff are allowed to work in the home. Checking out prospective staff’s employment history where there are gaps in the information provided on their application form. Making sure that the arrangements for supervision new starters, for whom all checks have not been returned, are clear and recorded, so they are not left to work alone. This will provide people with extra protection from staff who may be unsuitable to work in the home. 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 OP7 Good Practice Recommendations The assessment tool provided to periodically reassess people’s overall needs and risks to their welfare should be DS0000069199.V374270.R01.S.doc Version 5.2 Page 30 Kingsley Nursing and Residential Centre 2 OP27 3 OP31 completed at the intended intervals. This gives the opportunity for staff to reflect holistically on all areas of care, and how one change in need may affect another. The numbers of staff available to people should be kept under close review, based on people’ needs and expectations, and revised where necessary, to make sure these people get consistent and timely nursing and personal care from staff that they know. The acting manager should be given continued support whilst working in this position, and until the new manager takes up post, so she is able to manage the home successfully in the best interests of those who live there. Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. Extracts may not be used or reproduced without the express permission of CSCI Kingsley Nursing and Residential Centre DS0000069199.V374270.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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